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Generative AI is a known disruptor in healthcare today. Will this transformational technology be embraced by clinicians, patients, and healthcare organizations? Listen in as two experts from Accenture Healthcare and Oracle discuss the difference between traditional AI and GenAI, the opportunities that GenAI is presenting to the industry, and the need to lean in to utilize technology as an enabler and a change agent. Hear how care delivery can be reimagined with GenAI and how this technology has the potential to be applied to help reduce clinician burnout, augment the clinician-patient relationship, bridge workforce shortage gaps, reduce margin pressure, and more.
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Episode Transcript
00:00:00:17 - 00:00:22:10 Michelle You're listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data and technology to improve health for everyone. Hi, I'm Michelle Flemings. I'm the industry executive director for Health Care for North America Cloud Infrastructure at Oracle. Glad that you're here. We're in the age of artificial intelligence.
00:00:22:12 - 00:00:41:29 Michelle The opportunities that we're presented with using A.I. as an industry are truly groundbreaking. And to be honest, I think we're just getting started. I want to focus today on a subset of traditional AI and want to talk a little bit about generative AI, some of the ramifications, some of the risks, benefits and what does it mean to health care.
00:00:42:01 - 00:00:47:29 Michelle I am delighted to sit across today from Tej Shah and I'll have him introduce himself.
00:00:48:01 - 00:01:08:00 Tej Thanks, Michelle Tej Shah I'm an emergency medicine doctor, a managing director, and Accenture's global health care practice. I've got a ton of experience working across different parts of health care as a consultant, obviously, but also as a venture capitalist, investing in companies and most recently starting a company in the health tech space.
00:01:08:00 - 00:01:16:07 Michelle We're talking about AI and we always have to start with what is the comparison between traditional versus generative AI?
00:01:16:09 - 00:01:17:21 Michelle How would you put that?
00:01:17:23 - 00:01:41:11 Tej We've been talking about AI for 50 plus years. This is not a new thing. We've been talking about how we can leverage data to get insights going from analytics to AI to GenAI. Really the difference is, you know, before with AI we were able to extract data and insights from data so we could figure out what the next obvious data point was going to be.
00:01:41:13 - 00:02:19:03 Tej And in 2017 there was an article that was published by Googlers around attention is all that matters, right? And what happened with that papers is we came up with a completely new framework where we're now able through GenAI to not just predict what's the next data point, but understand what's the next word that we can generate. And it's taking into consideration the context of the sentence to be able to make that prediction so that it's actually appropriate and it's opened up a whole bunch of opportunities that we're going to talk about today that is really transformative.
00:02:19:05 - 00:02:30:03 Michelle Let's get into some of those opportunities. I think it's fascinating that it's been as long ago that A.I. came about and the general public really doesn't know.
00:02:30:03 - 00:02:35:14 Michelle let's talk about some of the opportunities in patient care that exists because of where we are now.
00:02:35:14 - 00:02:40:28 Michelle With A.I.. We do a lot around documentation. Where else should we be going?
00:02:41:00 - 00:03:08:03 Tej Back in 1996, you know, we started using search engines and it wasn't really until early 2000 when Google came around and the search bot search box became our librarian and around that time there was an article that was published by Will Carr in The Atlantic called Is Google Making Us Stupid and what he really meant.
00:03:08:03 - 00:03:33:29 Tej when you read the article was, are we thinking differently? Are we using our brains in the same way or reading as deeply as we did before? And obviously the answer is no. I think we continued to use our brains and we continue to, but we were using this tool as a librarian. We were using it to identify information quickly and be able to access it, you know, more readily.
00:03:34:01 - 00:04:04:19 Tej And what GenAI has done for us is start to be an advisor. It's enabling this transformation from technology, being a librarian to an advisor and that's what we're using AI for now. And GenAI today, right? So this idea of documentation and this is all relevant because the next sort of wave of what we're going to do with GenAI is it's going to start to act as an agent.
00:04:04:21 - 00:04:30:28 Tej It's going to start to enable us to take these tasks away from the from our day-to-day workflows and enable us to operate more efficiently. There is no reason, for instance, that a doctor like you or I should have to, you know, once we've submitted that a patient needs to do a specialist appointment, continue to follow up, make sure that that appointment was scheduled and have a bunch of people that are in that workflow follow up on it.
00:04:31:01 - 00:04:49:27 Tej It should just happen. And I think that generative AI is going to create these agents and these agents are going to be linked to one another. We're going to chain them together and it's going to do that follow up. It's going to make that experience more seamless, really enabling clinicians to do the work that gives us joy.
00:04:49:29 - 00:05:07:07 Michelle Let's drill down on that now, because you said something fascinating there being an agent. How I see it as being is now, I don't have that extra chaos and clutter to remember. As an ER doc, we're in the midst of the chaos we are in and we're trying our best to multitask. And there are fewer of us now.
00:05:07:10 - 00:05:25:16 Michelle There are others that are doing an exit now and then. We also don't have as much of a pipeline because, as you know, some of our residency programs didn't fill out. So three years from now, we're talking a massive deficit. And across the board in health care, there has been an exodus and a shift out of health care to other careers.
00:05:25:19 - 00:05:45:23 Michelle How do you see then us utilizing Gen AI to augment and maybe bridge some of those gaps with our shortages? The agent is great, but can we maybe think about a couple of other things that maybe might be even more magnificent? Like it's maybe front office, back office? Is there opportunity there, you think? Because we don't think about them a lot.
00:05:45:23 - 00:05:47:04 Michelle I do believe, absolutely.
00:05:47:04 - 00:06:10:27 Tej So let me just start. The clinician shortage is durable and it's secular. This is something that I say over and over again. You know, we have projected forward what we anticipate the workforce in health care is going to look like. We know there's going to be a shortage. But if you look at some of the research that's being published now, just at the end of last year, there was a study that published that looked at nurses and doctors that are in school today.
00:06:10:27 - 00:06:43:15 Tej And, you know, you might know that of those surveyed students, between 20 and 30% of them said they're going to drop out. They don't see the future of health care as a promising career that they want to pursue. That's going to be fulfilling in the way that maybe when we were going to school, we saw. And I think that's really disheartening because truly I think that, you know, when the way I thought about health care and the way the reason I pursued a degree is because I wanted to take care of people.
00:06:43:18 - 00:07:05:18 Tej And what's happened along the way is so many things get in the way of that, Right. That joy that we were talking about that I mentioned, that's gone because we've got so much administrative burden, so many distractions that sort of pull us away from that day to day care. It's actually started to deteriorate or continue to deteriorate.
00:07:05:18 - 00:07:28:18 Tej That relationship between the doctor and the patient that I think is so sacrosanct. It's so important. And I think patients want it. Physicians want it that nurses want it back. And so when I think of front office and back office, it's not just agents that are going to be doing this work. What it's going to do is it's going to take those tasks away, but it's also going to start to transform.
00:07:28:25 - 00:07:55:11 Tej What role, as a clinician, I play in the delivery of care, right, where maybe 30, 40% of my time I was it was taken up by doing that administrative work. Now I'm going to have it back to refocus on the patient. And it doesn't just drive productivity improvement, it drives greater engagement, it drives better experience for us as clinicians and for patients.
00:07:55:13 - 00:08:19:10 Michelle So back on Joy, I would love to be back there as well, cause I remember that feeling my first, but the patients and I could do anything and everything and this was going to be magnificent. And then you're right. Little by little, the administrative stuff started to become a burden. With GenAI,, how do you see us being able then, in this world of technology, having unfortunately had that adverse effect?
00:08:19:10 - 00:08:45:15 Michelle And I think it was an unexpected consequence of all of the information coming into the EHR and all of the information coming at us, period, whether it's on our phones, on our on our laptops and still faxes and message centers and inboxes. How do you see Gen AI as being able to be the thing that we can get providers to say, I trust this, I'm going to buy in, I will do this.
00:08:45:17 - 00:08:51:16 Michelle Because the last time we petted the dog, that was technology, it bit us and we have a long memory.
00:08:51:19 - 00:09:23:16 Tej Yeah, you know, the EMR is a beautiful thing, right? It actually transformed and improved the quality of care. It helped us, you know, document how we were taking care of our patients and enabled us to move patients seamlessly from one provider to another. But you're absolutely right. When you look at the data around the impact to productivity of the EMR, there's a 13% reduction in clinician productivity because of it.
00:09:23:18 - 00:09:51:05 Tej And I think, as you said, clinicians have been burned by it. I think we feel as though we were betrayed. We feel as though, you know, it didn't help us do our jobs better. It didn't help us improve the relationships that we have with our patients. And I think as we think about deploying new technology into care delivery, we're going to have to do a much better job of articulating the value proposition of what the technology is.
00:09:51:07 - 00:10:07:24 Tej And we're going to need to pull in clinicians to think about where it gets deployed, what part of the workflow should be addressed by technology and what should it take over. I think there's a lot of work for the industry to do. We're not good at it. We haven't been.
00:10:07:27 - 00:10:11:29 Michelle So how does Accenture then take away that hesitation?
00:10:12:02 - 00:10:35:28 Tej You know, so we're in the early innings of what GenAI is going to be able to do of where technology is going to be deployed. Truly, I think the organizations that are taking the leap forward and adopting and figuring out, you know, how technology is going to be integrated into care delivery, are taking some really basic steps. They need to have a policy on generative AI.
00:10:36:01 - 00:10:59:06 Tej They need to have governance, they need to figure out what is their data architecture and what's that foundation going to look like so that they can access that data to enable their clinicians to deliver care. They're going to need to think about on the back end how they train their clinicians and, you know, when they actually eventually do deploy technology, what is it going to look like?
00:10:59:07 - 00:11:03:26 Tej How is it going to transform the way that they work, the way that they deliver care.
00:11:03:29 - 00:11:25:28 Michelle Wow, transforming the way that we do work? When you say that, I think to myself, gee whiz, it would be marvelous. And in my mind, I would love to be able to be the ER doc seeing the cardiac chest pain patient and the intuitiveness of the system being that it understands who I am, what I do, what's going on with my patient.
00:11:26:00 - 00:11:42:25 Michelle It then brings in from the EHR what I need to know then, but then also helps me to go along with the best practice guidelines and recommendations while not forgetting that other stuff that you were speaking about before. With regard to referrals. Do you think that that's possible?
00:11:42:27 - 00:12:14:07 Tej So when I built my company, the fundamental premise that I was going for is technology should always be in the background. It should not be the reason that we get up in the morning and do anything right. It should be the enabler, it should be the assistant, it should be that third year medical student or third year resident that just enables you to do your job and perform at your peak all the time and think somewhere along the way, you know, we didn't sort of catch on to that.
00:12:14:09 - 00:12:29:12 Tej And I do think that with generative AI that we have the potential to drive that type of experience for clinicians who really are customers and clients of health systems. And we need to start thinking about them that way.
00:12:29:15 - 00:12:52:13 Michelle So I have two questions on that. We also spoke about the P word productivity. And as physicians, especially ER, we know that that can be something of a double-edged sword. So a lot of us want to frame it, couch it, present it more so as efficiency and effectiveness. How do we bring that message across with trust?
00:12:52:13 - 00:12:54:22 Michelle Because there is trust to be rebuilt.
00:12:54:24 - 00:13:20:08 Tej Yeah, you know, it's a great question. I agree that it's a double-edged sword. I think, you know, we productivity is what the organization cares about, but it's not necessarily what a clinician cares about. You know, their schedules are full, they're overloaded already. They're seeing more patients than they want to, and they're stretched way beyond, you know, the schedules that they're supposed to be working.
00:13:20:10 - 00:13:40:09 Tej And it's a lot a large part of why we're seeing the burnout that we're seeing amongst clinicians today. And so I think as we again, as part of how we think about technology and where it gets deployed and how it gets deployed, we have to bring the clinician along. And I think we have to think about what are the messages that are going to resonate.
00:13:40:09 - 00:14:04:12 Tej Just like when you do any sort of change program at any organization, they care about taking care of that patient and how do we articulate it to them that this technology is going to enable that, that this technology is going to power the experience that they want? Again, going back to this idea of the clinician as a customer or a client of a hospital system.
00:14:04:19 - 00:14:27:22 Tej Right. Because 75% of clinicians are employed now. Right. And if we think about them as customers that are, you know, they're producing the outputs that we want, which is units of care, we've got to figure out what resonates with them, what makes them tick, what's going to get them up in the morning and help them use the technologies that we're going to make available.
00:14:27:24 - 00:14:33:28 Michelle What's going to get them back at the table to actually have that conversation right, Because they need to be there. We need to be there.
00:14:33:28 - 00:14:36:07 Michelle So going back to burnout, burnout is not new.
00:14:36:07 - 00:14:52:20 Michelle And the question I have for you there is with regard to burnout and AI, do you think that there is meaningful use in there that we can honestly really tackle that meaningfully and impactfully?
00:14:52:23 - 00:15:00:25 Michelle Or do you believe it's going to take a long time, like decades worth of time to get there? Big questions.
00:15:00:25 - 00:15:24:22 Tej Yeah. And you know what, Michel? I'm not sure I have the perfect answer to it. I think what I'd say is we have to try. I think this technology has the promise to change how we practice, to create the space for us to do the thing that we had intended to do and take away all of that distraction.
00:15:24:25 - 00:15:58:27 Tej But I think we also need to think about ways that the technology can change the roles that we play as clinicians right. And you know, how it can augment us in different ways or automate some of the work that we're doing. And that's going to require real analysis of workflows. It's going to require real, you know, work and effort to rethink and rejigger the jobs for clinicians as a whole.
00:15:59:00 - 00:16:05:22 Michelle So there's a receptiveness there to an acceptance there that we are going to have to change. And we're not known for being change agents now,
00:16:05:22 - 00:16:31:23 Tej There's a lot of fear. I think there's,I want to keep doing things the way that I've done them, but I know that what I've been doing is not working and I think it's going to be a very tricky sort of journey for health systems and for us as we work with them to help them navigate it, because every system is going to be different and you know, it's going to depend on the culture.
00:16:31:23 - 00:16:53:09 Tej But I think we need to get to and this will take a little bit of time is for clinicians to start having the culture of being accepting of change because you know it, I know it. I think everyone that's going to be listening to this knows that this is not the end. This is really the beginning of real transformation.
00:16:53:11 - 00:17:10:01 Tej And the change is going to come fast and furious. And what we need to do is prepare our clinicians and organizations to know and expect that and help them understand how to navigate that. And I think that's going to be a long and durable journey.
00:17:10:04 - 00:17:12:10 Michelle It will be. And you say fear.
00:17:12:10 - 00:17:30:08 Michelle how do we start working to allay some of those fears and trying to get to the point of balancing out even just being straight up facing Gen AI as a functionality that has so much opportunity and then proceeding to that lean in, how do we help people to do that?
00:17:30:10 - 00:17:34:02 Tej I think we're never going to take humanity out of health care.
00:17:34:02 - 00:17:43:12 Tej Health care is about, you know, the clinician and the patient in that relationship and navigating the health and staying and remaining healthy.
00:17:43:12 - 00:17:52:10 Te In the short term and in the medium term, we're in this transition phase from technology being librarian to an advisor.
00:17:52:14 - 00:18:20:17 Tej And it's going to be an advisor for a very long time. That transition to agent is going to happen, you know, very quickly on administrative work, but it won't become an agent on the clinical side because I think we still need to use our judgment. That's what we were trained for. We know what's right for that patient and getting that advice, getting that support being augmented by technology is not outside the realm of what should be possible today.
00:18:20:22 - 00:18:30:02 Tej It's available right now, but that role is going to need to change. Right. What we do every day will change and will shift.
00:18:30:04 - 00:18:55:15 Michelle I love, though, the vision of returning to being that empathetic partner who helps to guide the patient through this journey back to health or to maintaining wellness, that would be phenomenal as opposed to always having people fall into gaps and into holes. And with that, let's talk a little bit about what GenAI may or may not be able to do with regard to access and health equity.
00:18:55:17 - 00:18:57:07 Michelle Let's talk a little bit about that.
00:18:57:07 - 00:19:25:08 Tej Yeah, You know, the shortage of clinicians that we're seeing around the world, it's not just the U.S., right. The projection is 10 million shortage over the next decade. And that disproportionately affects patients who don't have the means to access care. As an emergency medicine doctor, you appreciate the number of patients that come in as a site of last resort because they have no place else to go.
00:19:25:11 - 00:19:52:20 Tej It actually is not very convenient because the wait times are just getting longer and longer. And so what we're seeing is the disproportionate impact of the clinician shortage on populations that, you know, have not historically had. The means to access care. And so what I think and what I believe is with technology, as we scale capacity and we retrain clinicians on what their role is going to be, we're going to create access.
00:19:52:20 - 00:20:03:28 Tej We're going to start to address the health equity challenges and barriers and inequities, really that that we see as a society, not just in the U.S., but everywhere.
00:20:04:00 - 00:20:06:05 Michelle Beautiful, beautiful.
00:20:06:05 - 00:20:25:16 Michelle How do we introduce GenAI to patients and have them accept that sometimes they're not going to be able to talk to the nurse and ask the nurse when the pharmacy is open and understand why that's important and how this technology is also intended to serve them and to help them to do better.
00:20:25:16 - 00:20:43:19 Tej there's really two things that are really important related to AI and how we make it available to patients. One is around having, you know, a framework around responsible AI. And when we make the technology available to patients and for what use cases, because you're not going to it's not general availability for everyone.
00:20:43:21 - 00:21:01:28 Tej And then the second thing is, you know, we have to understand how we segment the patients that we serve, because your 91-year-old aunt may never want to interact with technology in the way that I do or that a 25 year old does. And I think we have to respect that and we have to appreciate it.
00:21:02:00 - 00:21:32:17 Michelle So we've hit now patient, we've hit provider, let's hit the hospital organization. They’re the decision makers ultimately as to what comes in, what gets implemented, what gets discarded or what what's put on by the backlog or the back burner or how do you see the conversation going with hospital decision makers about going forward with a roadmap that includes AI?
00:21:32:17 - 00:21:49:03 Michelle Because a lot of the discussions that I'm having are we want to see somebody else dip their toe in, we want to see somebody else dive in and survive. How do you see that conversation going or how would maybe you approach that conversation with someone who is a bit hesitant and wants to stand back a little bit longer?
00:21:49:03 - 00:22:09:01 Tej the truth is there is not a choice that health systems are going to have to make the investment in AI and GenAI, because we're all facing, you know, really critical workforce shortages. And we need to create capacity right now and we're going to need to do it in a durable, you know, long term way.
00:22:09:04 - 00:22:29:19 Tej The truth is there's a billion different applications of GenAI and, you know, we don't need to explore all of them all at once. Right now. What we need to do is very simple things around the investments in AI. You know, we have to have a responsible framework and governance and a policy for how we're going to deploy it.
00:22:29:21 - 00:22:57:07 Tej What's the oversight going to look like? We need to have that technology foundation and the data foundation to make sure that we're really leveraging all the data that we have. And truly we have to think about how we train clinicians and the rest of our workforce to adopt the technology so that when we get to scale, it's going to be used, it's going to create and have the type of impact and the ROI that we want.
00:22:57:09 - 00:23:17:26 Tej I guess the last thing that I would say is right now, GenAI touches so many different parts of a health care organization. It's not just the chief medical officer, it's not the chief nursing officer, it's not the Chief HR Officer It's not the Chief Operating Officer. It's not the CFO, it's not the CIO, it's not the CTO.
00:23:17:28 - 00:23:43:23 Tej And really figuring out in the context of, you know, an industry wide sort of, you know, crisis around margins, right? Where margins are in the low single digits, you know, and negative for more than half of the health care systems in the U.S.. How do you make this investment in the context of where a lot of other things are burning?
00:23:43:26 - 00:23:59:11 Tej How do you prioritize it and who do you go to and who makes the decision? Who who's going to be accountable? Who's going to drive the transformation? Who's going to drive the training? Who's going to drive the change? I think health systems are trying to figure all of that out and they need help.
00:23:59:14 - 00:24:28:23 Michelle They do. They do. They're going to need a partner who's going to be able to sit with them and understand where they are. More so, though, a lot of other discussions I'm having are people want to just kind of throw air out there as the panacea and the magic wand to fix everything. And there's a real struggle to contain it and say, let's pick one goal, something that is small yet impactful, that doesn't derail the ability to do care, doesn't disrupt your whole organization.
00:24:28:25 - 00:25:00:21 Michelle And those are some of the most impactful and beautiful conversations. And then when you get it right and they have a win under their belt, maybe tomorrow, I in the way of provider satisfaction, retention, patient engagement is better. Those sorts of discussions and those sorts of wins are huge. So I think that it is incumbent upon us and our positions and others out listening to this and similar positions to be that selfless advocate slash partner to your customer and help them along this path because it is complicated.
00:25:00:21 - 00:25:16:00 Michelle Let's talk a little bit then about health care, utilizing technology to catch up with other industries, because other industries are fairly far ahead of us when it comes to tech and efficiency and productivity, using technology.
00:25:16:00 - 00:25:41:12 Tej A lot of us like to say that if you want to know what's coming next in health care, look at what happened in other industries 20 years ago. What's incredible to me is that generative AI is being contemplated and probably more advanced in health care than it is in several other industries today. And it's almost moving at pace.
00:25:41:15 - 00:26:03:14 Tej And I'm not really sure exactly why that's happening. I think that, you know, maybe it's the shortage, maybe it's the margin pressure, maybe it's the potential, maybe it's, you know, some of these thought leaders that are really expounding on its use and its application, its potential in health care. Maybe it's just the burnout that's happening amongst clinicians.
00:26:03:14 - 00:26:17:14 Tej None of my clients on the provider side can afford to wait for the perfect sort of, you know, what are all the use cases and how do I sequence them and everything that I'm going to do for as you said, for the next five or ten years?
00:26:17:17 - 00:26:52:29 Tej I think we have to start now and there's a place to start right now. There are things to do to prepare yourself for that future and I think we're going to be astounded by the creativity of the clinicians that that you and I work with and that work for these organizations on how the technology can be deployed. And I think we have to just be open to it because I think we're going to see the potential and, you know, sitting behind a desk or sitting in a lab, you know, looking at the technology and thinking of use cases, that's going to get us only so far. We have to put it in the hands of
00:26:52:29 - 00:27:04:27 Tej clinicians having the appropriate sort of governance and guardrails. But that's how we're going to learn what it can do and how it can help and how it's going to impact, you know, how we deliver care.
00:27:04:29 - 00:27:09:21 Michelle That sounds like a great call to action. ‘Come to the table, your seats waiting’. Let's do this.
00:27:09:21 - 00:27:13:05 Tej Yeah, let's do it. I mean, ER doc, right? Like, let's go.
00:27:13:12 - 00:27:30:15 Michelle I love it. I love it. Well, thanks for your time today, Tej. Thanks to our listeners. Be sure to subscribe to the Perspectives on Health and Tech podcast for more insights from industry experts, visit Oracle Dotcom Slash Health or follow Oracle Health on social media.
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You're listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data and technology to help improve health for everyone.
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David My name's David. I'm the chairman of Oracle Health. And before I introduce this esteemed panel, there's a few patients that I've cared for, and I'm a child psychiatrist that have just stuck with me. And for a lot of reasons. Well, I actually feel like for whatever long I've been in this 30 plus years, I'm just trying to make it better for these patients and their families.
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David So let me describe them. And I think it really sets the stage for the role of technology in mental health. Okay. This little girl in third grade at the local school where my kids actually went to school writes in her haiku poem that she wants to commit suicide. And this is pre cell phone guys pre technology. The teacher reads the haiku poem and tells the prince at home that night tells the principal.
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David The next morning, the principal then calls the mother at home. And then this is L.A. And because they knew people, they were able to get in to see me in three weeks. And I was like, my God, if my kid was suicidal, it doesn't matter who, you know, you got to be seen today, right? I didn't know this word, but I know.
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David And now I'm going to fix access. I mean, that's what we use is this term access to me is my kid is suicidal and I'm calling an 800 number and my insurance doesn't cover it or I got to pull strings and God forbid I'm from the other side of the tracks where I don't know anyone. I will never get it like.
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David So how can technology help there? Right now, I think what we're supposed to talk about, too, is the negative part of technology, right? I'm stuck on my phone. I'm not I'm not socializing. I'm, you know, we all go to dinner and we're like this instead of actually being together. So why don't we go down the line and introduce yourselves?
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Michelle Okay, everybody, I'm Michel Patrick Quinn, and I'm a psychologist and a child psychologist, and I'm director of research at the Menninger Clinic and an associate professor at Baylor College of Medicine. I'm excited for this conversation. The Menninger Clinic is really known for humane treatment of mental illness. We are historic, known as an inpatient psychiatric hospital and really revolutionary and something called the therapeutic milieu.
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Michelle And so kind of actively intervene and doing psychotherapy while someone is inpatient. So it's not a passive intervention. And it's really just remarkable. We still hold on to that kind of psychotherapy within an inpatient context.
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Tracy I am Tracy Neal Walden. I'm a clinical health psychologist. I work for I'm the chief clinical officer for Coimbatore and Network. We're a network of mental health clinics across the US. We have clinics in 16 states covering, supporting 25 states. So and that's because of telehealth. So we utilize we don't do solely telehealth, but we've been able to utilize telehealth in order to expand our reach across the US.
00:03:18
Tracy I'm also a veteran of the United States Air Force. I served for 24 years and served as a psychologist during that time in the Air Force as well. We serve not only the veteran but the veteran's family members. As a veteran, myself, my family doesn't have access to care in the VA, and that's no fault of the VA.
00:03:37
Tracy It's the way the system is set up. And so we're able to reach and provide those resources to families and in a much shorter time period, especially due to the advances that we're going to be talking about now with technology,
00:03:53
Danny Thank you and so I'm Danny Gladden. I'm the director of behavioral health and social care for Oracle.
00:03:59
Danny Happy to be the social worker on the stage. And I really proud to work with just a whole group of social workers in the delivery of mental health services and all the great work social workers do.
00:04:11
David Today, what in your organizations is happening from a technological standpoint that you think is improving access, improving quality, democratizing care, making care more affordable, more culturally sensitive, helping with, you know, inequities that we know that are in care? What are you doing to harness technology that's actually helping individuals, patients, families, communities? Sorry, go for it.
00:04:34
Michelle Yeah. So it's not really revolutionary in any way, but we use iPads and research assistants and collect outcomes data across our whole hospital and with inpatients in outpatients, outpatients, it's pretty standard. People are able to complete, you know, outcomes, measure, self-report, inpatient. It gets more complicated. And we have to we have to guide people, help people. Some good times, people resist, don't want to do it, and that's fine.
00:05:00
Michelle They don't do it. But that to me is the foundation, right? So if you collect outcomes data that gives people a voice in their treatment, particularly on inpatient. So our inpatient units are locked units, you have reduced someone's on autonomy when you measure how they're doing, from their perspective, it gives them some control back. And I think that is one of the most powerful things that we can do is give people control back through data and measuring these things and measuring the change over time.
00:05:32
Michelle Whether it's positive or negative. And technology allows us to do that. So many of our patients want to use the iPad, and then we visualized the data in graphs that are provided to the treatment team through our electronic health record. And so that gives data driven feedback that the treatment teams can actually provide to the patients at the patient level.
00:05:50
Michelle We also use it for research to understand like aggregate results, what's working for who and what's not. But I think, you know, I'm biased, I'm director of research, so I love data. I'm the PI over our outcomes. But I think that's tremendous. And we can advocate for better inpatient environments, better inpatient care, better inpatient outcome.
00:06:12
David Can you? I think it's a great example. First of all, the simplicity of it is sometimes to make things simple. It's really hard and so this is great. Can you give an example of something you've done based on the data to change how care is delivered?
00:06:23
Michelle Yes. So well, something we're working on right now, all of our results are lining up really around the role of sleep. One thing we are constantly thinking about is suicide risk with inpatient, and particularly suicide risk post-discharge for those of you who may not know post-discharge from inpatient is the highest risk period for suicide. Over and above any other time in someone's life and also relapse.
00:06:52
Michelle So post in our highest level of care. And to us that is incredibly concerning. So we have been really thinking about the role of sleep as well as other measures and look at longitudinally outcomes while someone's inpatient what is predicting suicide risk and we have a paper that we published, we showed it is sleep over and above everything else that you can put in the model.
00:07:16
David And you measure using our rings and things like that or how are you.
00:07:18
Michelle Not yet. We are now because it is so important and we've now designed our own like API and with wearables to replace things that we do in inpatient that actually disrupt sleep. So like you, 15 checks and these checks. So there's checks done on inpatient to ensure someone's safety and sound checks. And these are often pretty disruptive. We have data now from active Griffey that we've lined up with the checks in about 75% of those checks.
00:07:48
Michelle So someone going in their room, usually a stranger that they do not know, opens the door, sometimes shines a flashlight in their face to make sure that they're breathing and that they're asleep. Or if they're not asleep, they'll ask them to raise their hand. And so and for us at our hospital, it's every 15 minutes that happens. That equals about 36 times a night.
00:08:06
Michelle Someone comes in their room. So we've designed our own kind of in-house homegrown system to replace that. And that is one and it's just one thing that, like we always say, you know, when technology is, you know, going to take over and ruin people's privacy, things like that. But in that situation, it improves people's privacy. People can sleep and be and have intact sleep.
00:08:29
Michelle Great. So it's that and that has just that's one of our favorite examples. Right. Just kind of generic outcomes data into a new intervention that leverages technology that improves some of these outcomes. Hopefully in the end we're still working on it, but so cool.
00:08:46
Tracy Yeah. I think it's really interesting what Michelle just discussed in terms of outcomes because we do measurement based care for all of our clients. So we measure their, their symptoms at every session and we do that via iPad. If they come into the clinic or we push it out electronically for those who are being seen for via telehealth.
00:09:10
Tracy And one thing that we found is that we actually we want to take a look at how effective is telehealth, because many people say it's not effective. You know, prior to the pandemic, people were very skeptical. And we actually use this data and we have a research institute that's part of our and veterans network. And within the institute, they reviewed the data recently and we found clinically significant change in Q nine scores is for depressed individuals and for those with PTSD, a clinically significant change in their PCL.
00:09:50
Tracy So these are the measures that are the standard measures given for those populations. And not only did we find clinically significant change, but we also found that those individuals were in remission. That's one of the things that I love about technology. It allows us to get those additional data insights. We rolled out telehealth in 2018, so before the pandemic, and we did it to improve access and not just access due to long wait, but to decrease no shows in to improve that accessibility for clients who were already in care.
00:10:29
Tracy I remember a few years ago I had a client and we would advertise in our clinic. We had rolling slides that would tell about the different things that we offered, and we had a slide that talked about telehealth and it said, Ask your clinician if you'd like to know more about it. And my client came in that day and said, Hey, would I be a candidate for telehealth because I fall asleep on the drive home from here and I was like, Yes, you being silly.
00:10:59
Tracy And that's also the beauty of telehealth, because it also it allows you to oftentimes squeeze additional appointments in if someone knows shows and it helps to prevent no shows, too, because oftentimes some people like to come in, they will they like to come in and see their clinician face to face, which is great. But sometimes life gets in the way.
00:11:23
Tracy And so if someone calls to say, hey, I'm going to be late, then we say, Would you like to convert that to a telehealth appointment so that they don't have to miss that appointment?
00:11:34
David Okay, Danny, take us home on that wonders of technology. Yeah. Then we're going to flip it.
00:11:39
Danny We're going to flip it. Okay, Well, so. So for Oracle, we build tools. We build tools to ensure that the work that providers are doing with consumers of care have what they need to sort of ensure that that, you know, the clinical experience checks the box so that, you know, the 15 minute check that Michelle was mentioning is something that happens in our tools and the screening and the screening that happens in our tools.
00:12:05
Danny We've embedded in the workflow for nurses, for oncologists, for the ED attending. We've embedded in the workflow a suicide screening tools and, and then and then alerts so that if someone is at risk, it's not just one person who's aware, but the entire treatment team can have this ability face up to this type of information. And so we sort of want to help folks use digital tools to be able to track patient information, to be able to get folks get folks in quicker.
00:12:37
Danny But I think beyond that, the beauty of technology in general is there's an opportunity to tell a fuller story, you know, through wearables, through some of the cognitive behavioral interventions, the digital therapeutics. It just really provides a variety of different types of modalities for consumers of care to be able to sort of deliver inputs about their experience.
00:13:02
Danny You know, if I have to get in the car, drive to a clinic to see Michelle in person, I'm putting on a mask. And all you really know about this individual is probably what happened an hour or two before they got to you. Like it's the stress of the moment using wearables, using sort of digital inputs throughout the week in between sessions, I'm able to I'm able to sort of have a more holistic picture of what your week looked like.
00:13:31
Danny And because you're doing the session in your own home, you don't have to put on a mask. It is more intimate. And I'm able to, as the provider, just have a more holistic picture of what I'm working with. Okay.
00:13:45
Tracy Can I add one more thing?
00:13:46
David You could add ten more things.
00:13:47
Tracy It gives you more accurate information. You know, as I was thinking about what you were saying, Danny, about the technology and you, Michelle, when you were talking about sleep, sleep is one of the number one concerns within mental health. People may come in with issues such as depression, anxiety, PTSD, but there's usually an underlying sleep problem. And as a health psychologist, I love to treat sleep, but clients history directly underrepresented the amount of sleep that they actually get.
00:14:19
Tracy And by using something like a wearable, a watch or a ring, you get that accurate data that then you can immediately share with them or they can see it immediately themselves.
00:14:32
Michelle I completely, completely agree with Tracy and Danny, and I think the beauty of the data when we talk about outcomes data, self-reported data, those data are collected, you know, every week. So you have huge gaps in the information that you are getting about somebody's experience. You know, our emotions can change within seconds. You know, there's a you know, can be a traumatic event happen or just a, you know, an argument with someone.
00:15:01
Michelle So our lives and our emotions behaviors are very dynamic and our outcome measures and the data that we have now is why I love wearables. And I've always loved wearables, psycho physiology, because it fills a tremendous gap in our ability to measure the dynamic fluctuations and the way our emotions and behaviors change. That is so important, I think, for understanding the ultimate outcome and just that that the kind of higher temporal resolution of the data is something we don't have now in practice.
00:15:36
Michelle There's such a research to practice gap there that I think technology will certainly fill in and also has the potential. And one reason I love the wearables, because it really demonstrates that it's not all in your head. Yes, too, when you do a self report, that is your perception, right, of how you feel in and with the wearables, too, it gives an objective marker for the first time in vivo in the situation to show, Hey, I'm really experiencing this, this is real, this is how I'm inside.
00:16:11
Danny Yeah. And I think about this just real quick. Like in our.
00:16:14
David Now we’re cooking.
00:16:14
Danny Yeah, I mean, well, in our discipline historically, you know, we don't we don't get access to labs, We don't get access to some, you know, some good radiology scan. We find out something about someone by asking a bunch of really nosy and intrusive questions by observation or someone has sort of engaged, you know, has had a crisis in their, you know, the courts or corrections or a probation and it is point in time, like, how many times do you start a session where, you know, how have you been since I saw you,fine, right.
00:16:49
Danny I mean, and that's sort of the starting point. So the ability to have real time inputs, the seven or the 14 days in between the times of seeing each other it just enriches the clinical experience so much.
00:17:03
David We're flipping gears. What are your concerns around tech not helping us, tech distracting us from human connection?
00:17:14
Danny I'll start us here. And so, you know, I, I still see I still see a few clients from time to time. I particularly enjoy working with adolescents and sort of the narrative from adolescence in the stories they sort of come up with in their mind about the world around them is really quite distorted, you know, based on the stories they get from social media.
00:17:40
Danny And I'm not talking about sort of what fake news, which is its own lane, but sort of the attitude that, you know, folks around me are just having a much better experience than I am. And what we all know is that there's likely all of it is inflated a little bit or a lot of it.
00:17:59
Danny Right. And so we know this. We know that the data on sort of overuse of social media and the link to depression and anxiety in young people is real. What we are seeing, though, is that transition, you know, it's not. So if I'm down, I'm feeling bad about myself. I'm now starting to engage in, you know, in ways to numb that pain.
00:18:25
Danny And that's, you know, through self-harm, through self-injury. It's, you know, through alcohol use or other substances or it's sort of engaging in relationships that are unhealthy. So I'm really I'm from the adolescents that I get to work with. I'm really concerned about that. On the other side, the part that concerns me about tech is, is I mean, we've just sat here and talked about all of the benefits that technology can bring, the access, the data, physio, bio physiology data.
00:18:55
Danny But the problem is there are people left behind, there are people left behind in the in the most remote parts of Alaska. There are there are folks that are left behind within a, you know, a mile radius around here. And so, you know, we have to ensure that that the tools that are created impact and benefit all of the people.
00:19:19
Danny And you know, so I think tech access, tech literacy, all are concerning to me as so much of our particular discipline moves into the tech space.
00:19:30
Michelle I'll kind of jump off from there. You know, I think when, you know, I'm not in the tech space, but I love technology. But I think technology does such a good job with some of these data privacy issues, and they do a lot in terms of the technicalities of how things are going to work with the interface. Looks like is are there protections in place, right, that safety is built in?
00:19:54
Michelle I think one thing that is forgotten, though, and, you know, I don't know if we even knew that was going to be a consequence is no one was testing the psychological safety of these technologies, especially when it comes to social media. Right. As we, you know, are kind of zooming forward with technology. There's all these, you know, kind of ethical safety guidelines, American Psychological Association.
00:20:18
Michelle These are really good job at starting to think about the psychological safety. What are the psychological kind of safety parameters that we need to test as we develop new technologies? But also then how do we put the guardrails up on the things that are here now?
00:20:35
David Tell me other things that concern you about technology and mental health.
00:20:39
Tracy I actually have another thing, and I'm going to shift it a little bit. I get concerned from the clinician perspective because we've technology has really helped us. We instead of, you know, giving a and I remember when we gave out the paper and pencil measures to our clients when they came in to the door, you had to wait for them to finish it.
00:21:01
Tracy But the good thing about that is when they did, then I immediately had it. I reviewed the scores. Now measures are sent to us, you know, automatically, and then they go into our system. And so you really have to train the clinicians to utilize that data and not just have the client submit their data without it being utilized.
00:21:29
Tracy Someone could submit data that could indicate that their risk status has changed. And if it's not being looked at, that's a huge concern. We're also looking at ways to help clinicians with documentation. However, a concern that I have with that too, is that, you know, if you're using AI to do your documentation, there could potentially be errors. And so we have to train our clinicians to properly utilize these wonderful technologies so that they can use them effectively.
00:22:03
David Yeah, we're working really hard on that. I think we've got good stuff coming out.
00:22:08
Danny Well, yeah, and, and actually so big because we don't have labs and radiology scan to sort of show a paper. Here's the evidence for the diagnosis. Our word, our discipline is very narrative rich. And you know, just to be able to sort of either get a prior authorization for service or to be able to continue service. And so we have a clinician burnout issue because of the administrative burden, the documentation burden.
00:22:36
Danny And, you know, so that's and the tech just facilitates that. But I do think is exciting, you know, ambient genitive AI and ambient for documentation. Our little our slice of the pie has been carved out and I'm so excited. And, you know, so Microsoft has gone there's some other startups out there that got Oracle's working on its tool that will really shift the burden away from documentation.
00:23:04
Danny I think it's going to be a game changer.
00:23:06
David Great gratitude to all of you folks, and thank you for participating. Thank you.
00:23:11
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Four women health care leaders discuss the value of connected health data, clinical studies at the point of care, neurodiversity considerations in data collection, and the importance of community care. This second episode on women’s health continues the conversation on how health systems need to change to eliminate barriers and address the needs of women patients to provide whole-person care.
Featuring:
Listen as they discuss:
“I think that it's really about how can we make these super busy people utilize the tools that work for them best … Because every data element I don't fill out as a patient is a data element a medical assistant, a nurse, a doctor is going to have to do instead, which means less time treating me like a patient.” – Dr. Sarah Matt
“Where you live has a tremendous impact on your health and well-being, not just at a country or state level, but down to the neighborhood level. And so when we can get that information in the EHR, then we're able to proactively engage based on transportation barriers, food insecurities.” – Christy Dueck, Ph.D.
“How do we pull that data together to be able to proactively reach into those communities? When I think about women and historically vulnerable populations, I think those are some of the same type of thinking and methodology that we have to leverage in connecting the data together, using data from a variety of sources to proactively identify populations, and then reach out to them.” – Dr. Nasim Afsar
“There are a lot of [technology] platforms I feel that have come on board, which just makes it more accessible for people. And then just thinking about different groups of people who may perhaps were not considered before, like neurodiverse, and are we thinking about them when we are designing the [technology] systems or thinking about their data and how to connect their data … How do they communicate with their healthcare provider? Do we have a lot of information about that? Neurodiversity covers quite a lot and there will be a lot of changes [to technological solutions] in terms of how we capture the information in a standardized way.” – Esther Gathogo, M.Pharm., Ph.D.
-------------------------------------------------------- Episode Transcript:00:00:00
You're listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data and technology to help improve health for everyone.
In the second episode on Women's Health Equity, we'll be talking about how the role many women play as caregivers can present a challenge for patient engagement. We'll talk about technology and patient data and how we can effectively unify our knowledge together to treat the whole person.
00:00:37
Hi, I'm Dr. Nasim Afsar, chief health officer at Oracle Health. And joining me today on the podcast are three of my colleagues from around the world. I'll ask them to introduce themselves and give a brief overview of what they do.
00:00:53
Sarah Matt Thanks, Nasim. I'm Dr. Sarah Matt. I'm a surgeon by training my fellowships and burns, but I've been in product development all over the world for my entire career. That's building our electronic medical records, new mobile applications, patient engagement solutions, you name it. First, I came in to drive our OCI, the cloud side of our business for health care and life sciences. And now, after our acquisition of Cerner, I focus on new product development.
Nasim Afsar Thank you. Esther?
00:01:20
Esther Gathogo Hi, I'm Dr. Esther Gathogo, and I'm a pharmacist with 18 years’ experience working across different sectors: community, hospital, academia and clinical research. And I currently work as a senior performance improvement leader in international based in UK. And I also focus on health equity and AI.
00:01:40
Nasim Christy?
Christy Dueck Hi, everyone, I’m Dr. Christy Dueck. I'm the vice president and global head of our Learning Health Network and really have responsibilities around creating health system partnerships with life sciences industries to bring clinical research as an integrated component of clinical care.
00:02:02
Nasim Thank you, Christy. And my background is in internal medicine. I practiced as a hospitalist for over a decade in tertiary, quarternary academic medical centers. I've been in health care administration on the health care delivery side for over sixteen years in roles, in quality roles, in health management, contracting and health care operations. My team is focused on how do we ensure that across the globe we have healthy people, healthy workforce and healthy businesses. Driving the best of products and services to ensure that we're improving the health of the world.
So thrilled to be here and thank you all for joining me today as we talk about women and health equity.
00:02:49
Nasim Afsar Many women prioritize the care of other people, their loved ones or family members above their own, and oftentimes may feel like they don't have time to take care of themselves or be able to do the extra research that's required or seek a second opinion. Some of the ways that technology can help partner with providers to ease that burden. Christy, what do you think about this?
00;03;17
Christy Dueck Well, I'm going to hit it from that clinical trial perspective again, as we look at ped's trials. We know the number one driver of not enrolling enough kids onto those trials is because the appointments happen when parents are working. And really when moms are working. And so it's, again, something as simple as we're changing that behavior so that we can bring that clinical trial out of a clinical research organization or at a specialty clinic that's 4 hours away from where that kid lives, and actually make it available at the point of care within their community on a Saturday morning so that a mom can take her kid to be part of that trial.
00:04:00
And instead of trying to create processes where we're enabling health systems and caregivers to work at optimum times, we've got to also create processes that actually allow our community members to engage in the care that they need on the time systems that work for them.
And so I think, Nasim, you know, exactly what you were saying is that if we're going to have moms engage in their own health and in the health of their kids, we've got to make it available for them at a time that works for them. And it can be something as simple as changing those appointment times, or the availability for them, that completely changes the outcome of a clinical trial.
00:04:42
Nasim Sarah, wondering about your thoughts on this.
Sarah Matt So for me it's really about options. So I'm here at my desk and on my desk I have this letter. They actually send me a letter from the doctor's office and it was about an upcoming appointment.
First of all, I'm in a generation that a letter is just not going to work. It's not going to cut it. But I was never given the opportunity to tell them how I communicate best. So if they would give me an option to use some other patient engagement tool, a portal email, a text message, literally anything else for me would be a better option.
00:05:20
But I think that's the trick, is that technology can allow for more options. So maybe Christy is a text person. Maybe Esther actually will listen to her phone messages. If someone calls me, they're never going to get a hold of me. But, you know, I think that it's really about how can we make these super busy people utilize the tools that work for them best.
And every health care organization uses patient engagement tools, whether they're using a third party for a kiosk in their office or a patient portal or other outreach mechanisms for population health. There's so many ways they can do this, and some populations are going to love that letter. Other populations, like me: please text me, please send me an email, because anything I can do by multitasking, anything I can do where I don't have to stay on hold and talk to an actual person is going to be better for me.
00:06:11
I think the second piece is really about the information in your medical record. Nothing is more frustrating than showing up to a doctor's office or for me with this letter, they sent me a whole packet of papers to fill out to bring with me to my appointment on paper. I know they're going to scan that. I know none of it will be discreet, structured information, which pains me because I know I'm going to have to fill it out again.
But if we can find ways to take a patient's record, to use it well, to send it to the next provider, to use HIEs, to use other mechanisms of interoperability well, then those patients don't have to get to the appointment or they don't have to worry about the information being they don't have to check it again and again.
00:06:54
Every time you write this information down, there's a chance I'm going to mess it up again. And I'm a highly educated patient. For patients that are really iffy about their health care, it can be even harder. I know for me, as I say, I have a ton of kids. When I am filling out paperwork for my four kids, I can barely remember all their birthdays.
You can tell it's going to be a mess. So any time that all that information can be instead sent to me to review and verify, I'm going to do a ton better than what I'm starting from scratch. And I'm probably not the only patient out there that's experiencing the same thing.
So for me, when I think about how technology can really help patients and that patient provider burden, it's about being able to transport and use interoperability in a really robust fashion to make sure my records go from place to place and then give patients options.
00;07:50
Because every data element I don't fill out as a patient is a data element a medical assistant, a nurse, a doctor is going to have to do instead, which means less time treating me like a patient.
00:08:02
Nasim
Sarah, I can promise you that you are not alone. And I look at the crazy amount of health care paper that lands in my mailbox. You know, your comment about options and preferences is ultimately an angle of precision medicine, right? It's getting health care the way that you want it, and you need it to be able to care for yourself. And I think we have we have a lot of work to do, too, to actually be able to get there.
00:08:34
When patients feel like the medical establishment is no longer listening to them, they sometimes turn to alternative therapies.
How can patients and clinicians work better together to make sure they're bringing all of the data and modes of health and wellness together to really treat the whole person?
00:08:53
Sarah Matt So when I think about brining, health, medical, wellness all together, I think that in the past, and even today, we often keep them in silos. So medicine is this and there's a big fence post around it and we don't think about what does that mean to the patient. What is wellness, what is mental health?
What are these other areas of health and wellness that are not necessarily part of our electronic medical record or as a part of our normal scope of practice. So first, I think providers need to really think past their training, and that's hard. As a provider who is trained in the United States, I was trained to take care of patients in a pretty specific way.
00:09:35
Fortunately, I'm from the generation that's worked on paper and electronically, so I've seen the full gamut of craziness when it comes to how to take care of patients digitally and not. But how does that intersect with chiropractic care or traditional medicine for different cultures or herbal supplement 27? Whatever it is. I think that as medical professionals, sometimes we know what our scope of practice is, and we know what we know really well.
But when it comes to a new modality of care, whether it's a nontraditional type of therapy or a new medication, that is maybe not an FDA regulated medication, maybe it's something that's herbal, we don't know what to do with that. And a lot of providers, I think, often will put up that wall and say that's not a good idea.
00:10:26
That sounds kind of crazy. Maybe you shouldn't do that. But I think that if we look to ten years ago, 20 years ago, 30 years ago, that's how we thought about a lot of things. Chiropractic medicine is a good example. Some providers are really excited about it, some aren't. But time and time again, all literature will show that for some patients it decreases pain.
So as a provider, should I prescribe chiropractic care? Ah, maybe not, but there's no denying that for some patients it's decreasing pain, and that's real. So what I'd suggest is first, sometimes as providers, we need to educate ourselves in some other modalities of care. Sometimes we need to recognize when some therapies are helping our patients, whether we agree or not, with the medical validity of it.
00:11:15
And we can help our patients understand what risks might actually be able. Will this medication actually do something in a negative? It’s helping this patient with pain, with depression, with this new thing. Is it going to cause harm in other ways? How can we help our patients do a risk analysis for themselves?
And when it comes to mental health, again, a lot of providers, me included, we have our scope of practice that we feel really comfortable with, and then we tend to refer out for everything else. Which is not a bad way to practice medicine, but I think it prevents us from thinking about what are those important and engaging human questions that we should be asking during our encounter.
Again, what are those personable things that we can do to show that we care and to help make sure that our patient gets to the right place next? Whether it's understanding a little bit about their life, about their struggles, about how things are going in their lives, I think that's important.
00:12:15
We often are concerned about how healthy they are or are they taking their medications the way they're supposed to. But I think we forget sometimes and rarely ask, how are you as a person? Because whether they hit those marks on the depression screen scale that my nurses give them, I think a lot can be said about when they speak to me in the office, if I'm concerned about them as a human being, and then I can help get them to the right resource or help give them some information that will help them on their journey better.
00:12:48
Nasim There’s such tremendous value, Sarah, in truly listening, understanding and empowering people to be able to take care of themselves. And then for us to having truly understood them, to help them in a different way. I really appreciate that perspective. Christy, I'm wondering about your thoughts on about how can we help patients and clinicians do better in bringing all of the data together?
00:13:14
Christy I think it's a couple of things. I think that as I was listening to Sarah, I thought of, you know, there's the social determinants of health aspect and then there's certainly the prevention aspect, where we're not just focused on treatment of a known issue, but prevention of issues presenting in the first place. From that social determinants of health perspective, you know, we know that beyond clinical data, there's so much more that impacts your health and well-being.
00:13:43
Where you live has a tremendous impact on your health and well-being, not just at a country or state level, but down to the neighborhood level. And so when we can get that information in the EHR, then we're able to proactively engage based on transportation barriers, food insecurities.
00:14:06
Nasim You know, Christy, one of the things that we talked about was how our various data on patients are in lots of different places. So that even if you have data with one EHR company and you see another health care delivery system that has the exact same EHR, those two parts actually don’t speak with each other.
And so when it comes to some very basic elements of care like colorectal cancer screening, we don't really have a good sense of what percentage of the population have been screened because we have data in all these different systems that don't really come together.
00:14:50
And really the strength of, and the privilege and the responsibility of, being part of a large data company that knows data and connectivity to look at how do we solve these problems, how do we really need a system where we can have a national, and then in every country across the globe, a way to be able to pull this data together, understand it?
And then there's another side of this where more data can be leveraged. Which is pulling data from lots of different sources and connecting it enables us to understand particular communities where there are, for example, food deserts: where we know patients are likely eating large amounts of highly processed foods, where the rates of alcohol consumption and smoking are much higher and those are going to be populations that are more predisposed for colorectal cancer.
00:15:49
How do we pull that data together to be able to proactively reach into those communities? And again, when I think about women and historically vulnerable populations, I think those are some of the same type of thinking and methodology that we have to leverage in connecting the data together, using data from a variety of sources to proactively identify populations, and then reach out to them.
00:16:14
Esther Just picking up on what I guess you've all said, but also what Sarah mentioned on the mental health, it made me think about digital therapeutics, an area which is growing. And even in Europe you have some countries like Germany who are now having like digital therapeutics on prescription as an alternative to giving medicine.
So I'm just imagining now in terms of how to connect some of this data from these newer applications where they've really started to show really good benefits when it comes to managing depression. And mental health is an area that I feel over the pandemic really changed the model of care and delivery and with a lot more people feeling comfortable to have their therapy virtually.
And so there's a lot platforms I feel, that have come on board in which just makes it more accessible for people. And then just thinking about different groups of people who may perhaps were not considered before, like in terms of thinking about neurodiversity and are we thinking about them and when we are designing the systems or thinking about the data and how to connect the data.
00:17:36
So if you think about someone with autism or a woman with autism and how do they describe or how do they experience, for example, I'm going to talk about menstrual cycle because I started with that, but how do they experience the menstrual cycle? How do they communicate that with a health care provider? And do we know a lot of information about that?
So in thinking, just because neurodiversity covers quite a lot and I think there will be changes, I think, over more incoming years, in terms of how we capture the information in a standardized way. Because then you can be able to connect the information across to be able to do research in certain groups. So I think it's quite an exciting point to be in, I guess this is this is like the pioneering stage of everything.
00:18:35
And just thinking about like we saw statistics in the UK, we have now reached 99% of households with Internet and there's more people even over the age of like 80 who've got mobile phones and they're learning to use smartphones. So I think and if you look at the smartphone and the way there's a lot of health apps on there—I think when you're talking about this whole trying to improve the physician and patient kind of relationship, this thinking about when I go home and I've been diagnosed with a condition and how to been instructed and how to manage it, how do I, what's my self-care looking like?
So when I go home and I download an app that's capturing information, it might improve on the follow-up care in terms of how you capture the information and share it with the physician in your next visit. And I think a lot of that is going to become more and more easier in terms of sharing information between systems so that you can be able to improve on just seeing that holistic view of your patient across. So I think it's quite exciting.
00:19:56
Nasim Yeah, I think that's that's a great point. What are some other innovative ways you've seen health organizations share information with their communities?
Esther Yeah, So we saw just over the pandemic an increase in social media use, particularly in low to middle income countries just looking for answers really to understanding like COVID and also the vaccine itself.
So we've seen an increase and they saw it as a potential tool to access hard to reach communities in terms of educating people in low resource settings on health care. And one of the things, for example, we had and within ECF last year there was Dr. Khyati Bakhai who delivered a talk on this where she was saying that she translated some information around the COVID vaccine to another Indian dialect, and that increased the uptake of the COVID vaccine within that community.
So you're starting to see how social media platforms, particularly if there's a really high usage of it, particularly in low resource settings, as another avenue to reach out to those communities, just to help them on understanding more about their health and also sharing credible health information through those platforms. And also just thinking about how you can use it as well and in terms of thinking how to reach out to them if it was, for example, for research or for understanding more around even like barriers to health care for them or understanding their needs.
00:21:56
Nasim Well, thank you all for joining us for the thought-provoking conversation about women and health equity. I want to thank our panelists Christy Dueck, Sarah Matt and Esther Gathogo. Great conversation around the role of technology and how can we address some of these shortcomings and limitations that we have for women to receive better care.
But lots of areas identified where we really need to work together in partnership to address as we move forward. Looking forward to ongoing dialog around this, and more importantly, action around how we can impact better health for women across the globe. Thank you.
Be sure to subscribe to Perspectives on Health and Tech podcast for more insights from industry experts, visit oracle.com/health or follow Oracle Health on social media.
In the last decade, a growing amount of research has increasingly exposed how a lack of funding for medical and pharmaceutical research around women’s bodies has put both patients and clinicians at a disadvantage for treating even common illnesses. With a lack of knowledge and awareness on women’s health, clinicians don’t have the data with which they need to practice, and patients don’t feel heard, some even experiencing bias at the bedside. How can AI and other technologies help address some of these challenges?
Listen in on this first episode of a two-part series.
Featuring:
Listen as they discuss:
The moment they realized, personally or professionally, there was a gap in women’s health care (2:47)
What is being done to address the lack of research on women and diversity amongst women (10:56)
What can be done to help address the lack of women and women of color in clinical studies (15:11)
The role of AI in care delivery (17:15)
Notable quotes:
“When we think about women's health in general, using more automation, using more AI/ML, could it help women in their ability to get care for themselves? It absolutely could … Because right now I think what we're finding is that the system’s stressed, all the people are stressed, the patients are stressed. Everyone needs a break and we can't do more with less. We're going to have to do things differently.” – Dr. Sarah Matt
“At the end of the day, we want to make, just like you said, those 15 minutes with the community members that you serve more impactful and with the option to bring more innovative things to your community than ever before.” – Christy Dueck, Ph.D.
“And we know that if there's such a low representation of women in clinical trials, it means that products are being approved without the representation of these women. And it means that the real-world evidence then becomes really important. If we are then using these products, we have to understand the female body and the diversity—in terms of the genetic background as well—and that diversity means that they might respond differently to the approved medicines. It’s also thinking about how to recruit and making it a lot simpler for women to understand the products.” – Esther Gathogo, M.Pharm, Ph.D.
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Episode Transcript:
00:00:00
Nasim Afsar You're listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data and technology to help improve health for everyone.
Today on the podcast, we're discussing women and health equity. From personal and professional experience, how we've become familiar with the lack of resources and research on women's health and how AI and other technologies can help address some of these challenges.
00:00:35
Hi, I'm Dr. Nasim Afsar, chief health officer at Oracle Health. And joining me today on the podcast are three of my colleagues from around the world. I'll ask them to introduce themselves and give a brief overview of what they do.
Sarah Matt
Thanks, Nasim. I'm Dr. Sarah Matt. I'm a surgeon by training my fellowships and burns, but I've been in product development all over the world for my entire career. That's building our electronic medical records, new mobile applications, patient engagement solutions, you name it. First, I came in to drive our OCI, the cloud side of our business for health care and life sciences. And now, after our acquisition of Cerner, I focus on new product development.
Nasim Afsar Thank you. Esther?
Esther Gathogo Hi, I'm Dr. Esther Gathogo, and I'm a pharmacist with 18 years’ experience working across different sectors: community, hospital, academia and clinical research. And I currently work as a senior performance improvement leader in international based in UK. And I also focus on health equity and AI.
00:1:37
Nasim Thank you, Esther. Christy?
Christy Dueck Hi, everyone, I’m Dr. Christy Dueck. I'm the vice president and global head of our Learning Health Network and really have responsibilities around creating health system partnerships with life sciences industries to bring clinical research as an integrated component of clinical care.
Nasim Thank you, Christy. And my background is in internal medicine. I practiced as a hospitalist for over a decade in tertiary quaternary academic medical centers.
I've been in health care administration on the health care delivery side for over sixteen years in roles, in quality roles, in health management, contracting and health care operations. My team is focused on how do we ensure that across the globe we have healthy people, healthy workforce and healthy businesses. Driving the best of products and services to ensure that we're improving the health of the world.
So thrilled to be here and thank you all for joining me today as we talk about women and health equity.
00:02:47
To start us off, I want to talk about the moment that you all realize that there is a wide gap in women's care and that could be either personally and professionally.
Nasim So, to kick us off all kind of share a story from my background. This really kind of hit me a number of years ago when I had the privilege of taking care of a 48-year-old woman with end-stage metastatic colon cancer during her final hospitalization. I learned during this hospitalization that leading up to her terminal diagnosis, for about a year, she had seen a number of providers with her symptoms.
Initially started off with fatigue. She then had some abdominal pains, some nausea, and this was continually attributed to stress, irritable bowel syndrome. And during those 12 months, she was really never provided the appropriate diagnostic interventions, like a colonoscopy, until it was too late.
I also learned during that time that she was a phenomenally dedicated teacher. She was a caring mother. She was a spouse, a child, a sister, an incredible friend to many. It was absolutely heartbreaking to see that her voice was not heard as she didn't receive standard of care that really could have been lifesaving. And I wish I could say that this was a rare case. But cases like this happen every single day in the U.S. and across the globe.
00:04:22
Christy, I'm wondering if you can share with us when this really became real for you.
Christy Sure. A little bit different story for me, and mine's actually personal. So, when I was studying pre-med, I was an intercollegiate athlete in rowing with aspirations of competing at the national and elite level. And like so many female athletes’ experience, I really got caught up in the cycle of being asked to lose a significant amount of weight by my coaches, because rowing, like other sports, has weight classifications.
So over the course of a summer, I dutifully lost 35 pounds and returned back in the fall at under 130 pounds, which is a light weight. And in about three months I had a full osteoporotic hip fracture at the age of 20. And it was really a peak milestone for me. I was in my junior year. I was pre-med at the time.
00:05:22
I was never given, obviously, any guidance around the impact that that weight loss would have on my health, my endocrine system. And so that was really a milestone of it ended my rowing career, unfortunately. But it was really a driver for my career. I went on and got my Ph.D. in reproductive endocrinology and did a whole lot of research around the female-athlete triad since I was sort of the poster child for it at that time.
00:05:50
Nasim What a challenging personal experience to go through. Christy, thank you so much for sharing that, Sarah.
00:05:58
Sarah So I think, you know, as I went through my medical training, you kind of see things, you hear things, if things don't seem quite right a lot of times. I think where it really hit me is when I started having my own children.
So, I have four kids, and my first, I was still doing surgery at the time. And when I think back to that time, there were so many assumptions made about what I, as a professional, might already know about women's health or might know about my own body, and that I didn't. And when I would ask caregivers, they would either be like, “Oh, well, you know, it's this or it's that.”
And I think that having come from the medical field and having a baseline of information already, I still didn't have the answers I needed. And I was relying on my grandma or my mother or my sister or friends to ask advice when I couldn't get what I needed out of the medical system. And as a medical professional, I needed information like, “Hey, if I'm going to go into a vascular procedure, do I need to wear lead?”
00:06:57
“Hey, is this chemical okay for me? What if I get exposed to that?” And yes, sometimes there was a paper that I could Google and sometimes I could ask my doctor, but sometimes there just wasn't. And there wasn't the right people for me to ask within the medical community or otherwise. So I can really see how people just struggle, because I had, theoretically, all the resources I could possibly want available to me, and I still couldn't get the answers that I wanted.
00:07:27
Nasim Thank you for sharing that, Sarah. It really brings out the part of the heart of the matter, which is even when you have resources and knowledge, it can be so incredibly challenging. And so many women across the globe don't have the resources and the knowledge. Esther?
00:07:46
Esther I'm just going to take us back to the early years of when you're probably a teenager and you had the reproductive health conversation. And I was in boarding school and we came back after having been given sanitary towels and shown tampons and everything else.
And I think at that point the main focus was on the menstrual cycle and what's normal. But no one really talked about how bad it can be, I think for most. And so I think what became very clear is when girls, you know, because that's the stage when the menstrual cycle is being regular, more regular, and you started to see serious, serious problems.
00:08:33
You know, we had one girl who had to be taken by ambulance and started on a drip for menstrual pain, you know, and it's something that hadn't obviously seen before. And then as we got older, the conversations where I've had friends who've had a hysterectomy before 40 for benign conditions. And when you listen as a group, particularly around the problems that people face with the menstrual cycle, you realize that there's not a lot of treatment options.
And this is after many years of many women coming in to the medical center and recognizing that 10, 15, 20 years down the line, we're still using hormonal treatments as the main treatment for most of the conditions.
And I think when you listen to how, you know, it's impacting the mental health, you know, the life and social life and just their well-being, then you end up realizing that over time, more needs to be done with this. You know, because I think the medical community has somehow become just complacent because they have benign conditions and they can see that it's, you know, in terms of self-management or whatever it is that women do.
00:10:06
But I think thinking about now, especially as we are working women and, you know, how stress affects your system, it's something that I think and just thinking about needing more options. And like even getting down to understanding the basic understanding of why the disease happens, you know, some of those questions are still, you know, they're not there. So that's why.
00:10:35
Nasim Thank you for that, Esther. I think you highlight the challenges of managing something that is as basic as it gets and it's biologic, and how much work and understanding still needs to happen for some of the most basic and biologic processes in women. So I really appreciate you sharing that.
00:10:56
So, we know that a lot goes into these gaps of care from lack of understanding or honestly acknowledgment of biases in vulnerable populations to lack of medical and pharmaceutical research considering women's health, I think you all touched on different sides of this. So let's focus on representation of women and women of color in research. What has been done to address this gap in research and data? Esther, I'm going to ask you to kick us off.
00:11:30
Esther Yeah, and I was reading a bit around this and just throwing out some figures that, you know, women are representative of 22% of clinical trial research.
And for women of color, it's been reported even as low as 2%. It makes you think about the information in terms of the clinical research, whether it's truly representative of the diversity of women, you know, across even the globe, if I want to say it that way. And we know that if there's such a low representation of the of women in clinical trials, it means that products are being approved without, you know, the representation of these women.
And it means that the real-world evidence then becomes really important. Which is where I think if we are then using these products, we have to understand that the female body and the diversity of all of us in terms of the genetic background as well—and that diversity means that they might respond differently to the approved medicines—is also thinking about like how to recruit and making it a lot simpler for women in terms of understanding the products.
00:12:51
Because one of the biggest things would be how does this product affect my body? Most of the time people are concerned about fertility, you know, and a lot has been done over the years to try and just put women's minds at ease. But it is difficult.
And this is where I find that the electronic health record and thinking about not just about that the information is within the record, but are you collecting information in the clinical care of women and representing it in that way and within if you're doing clinical observation studies, because if you've got a product and you're not, for example, collecting information on the impact on the menstrual cycle, but you're getting lots of reports from women saying they've had a few missed menstrual cycles and they don't understand why it could have been the product that they're taking. But if this information is not being captured, then it's not within the system, which means that you start you still can't glean the insights that you need from the electronic health care records.
00:14:03
So I feel that not only around and when you look at internationals looking at the numbers in terms of the proportion of women who are conducting clinical research as well, and that's quite low. So it can also then make you think about in the end, when are designing the clinical trials, is someone speaking up for the diversity of women to include them in the clinical trials or in the trial design?
Because then you are collecting the information that will be useful as well for women when it comes to evaluating whether or not they should take a product or they should be recruited into a trial.
00:14:51
Nasim So there's a real multi multifaceted problem, right? It needs to really be tackled from multiple, multiple angles as you highlighted. So, Christy, Esther highlighted how low representation of women and minorities as has carried out in clinical research. What are we going to do to fix that?
00:15:11
Christy Oh, that's a big question, but I think, you know, we got to we got to start with working with what we have in the most effective way. And so, you know, from my angle of the world, I'm not a practicing clinician, but I've been engaged in clinical research my whole career.
And coming from Cerner, we had this realization of, oh my gosh, we're literally sitting on 40 years of digitized health care data. How do we turn that as a giant lever to help address some of these broad stroke issues, like women and access to clinical research?
And so in my world, one of the things that we did was create a partnership with health systems and an opportunity for them to share their data with other health systems so that we could create a searchable dataset, a real world data set that we could then work in partnership with health systems to bring clinical studies that address issues in women's health to the point of everyday health care, and use that data as the accelerant to get very prescriptive in finding women that are a match for the specific study criteria or enabling care teams to engage directly with their patient populations that may be a fit for a new, innovative trial in a rural community that would never have had that opportunity before. So right now we're sitting at this critical point in health care where we know we've got a whole bunch of data.
00:16:51
That's our quality problem. We've got more data than we know how to use. And to Esther's point, it's now making that data a lever we can pull to accelerate clinical research, to focus on the specialty groups where we've seen disparities in care given up until this point in time.
00:17:11 Nasim Agreed. Agreed. So, you know, we've talked a couple of times around the role of technology in helping address disparities.
I want to focus in on the role of AI in health care delivery. What's the potential and what are the downsides?
00:17:30
Sarah So, you know, when we think about AI/ML it's been the buzzword for how many years now? And I think during COVID, everyone recognized that we have to do things differently now than we did in the past.
And so everyone’s heard about ChatGPT. It's been a huge buzz. Everyone wants to talk about AI/ML, but a lot of health care organizations, a lot of ministries of health, have been slow rolling in how they deal with AI/ML over the last couple of years. A lot of that has to do with trust and why would we be concerned about that for the same reasons that health care in general has had problems for decades and decades and decades.
00:18:04 So that means whether it's structured data coming from an electronic medical record, straight from a clinical trial database, wherever that data is coming from it, we have to make sure we're comparing apples to apples. And every single algorithm, every AI model that we build out, has to be trained.
So, when we think about women's health and how we can improve women's health, ultimately, there’s going to be models that are trained on data that doesn't include women. Well, how is that going to impact us?
If you think about all the different ways we treat people today, whether it's in nephrology and kidney health and the way African-Americans have been treated in the past, in terms of those algorithms, whether it's X, Y or Z, we have so many clinical rules that we use today that have their own inherent biases based on medical data from the past.
00:18:54
So if we're going to build out new algorithms, we have to make sure that we're training it properly. So things to think about for people developing these algos is: who is your set of patients that you're going to bring into this model? Are women included? Are people of color included? What other kinds of people should be included in this algorithm’s data set to make it a great model?
When we think about women's health in general, using more automation, using more AI/ML, could it help women in their ability to get care for themselves? It absolutely could. When we think about the nursing shortages all over the world, when we think about how hard it is to make a doctor's appointment on a Monday, when you have a bunch of kids, when you have a job, when you think about how much time a provider is actually going to take with you … how can we automate things for the patient?
00:19:48
How can we automate things for the provider? How can we provide that small town doctor feeling in 15 minutes? How can we provide that care and engagement with less? Because right now I think what we're finding is that the system’s stressed, all the people are stressed, the patients are stressed. Everyone needs a break and we can't do more with less. We're going to have to do things differently.
00:20:18
Christy I love that. I'm just going to jump in right now and do a high-five to you on that one, because I think, right, fundamentally—and, Nasim, you and I’ve talked about this before as well is—at the end of the day, we have to change our behavior around health and care, regardless of what side of it you're on, whether you're a provider of it or a receiver of it.
And that behavior change is what's going to drive our ability to be able to actually leverage and receive the benefits of all the cool stuff, Sarah, you just talked about. But if we don't change the behavior around health care as the starting point, it doesn't matter what great tools we develop if people don't use them. And so in my world, you know, we're trying to engage critical-access hospitals who have never, ever participated in a clinical research study before.
00:21:14
And the first thought and the first line of defense is, “I don't know how to do that. We've never done that. No.” And really, it's creating that opening of, “We're here to partner with you. We've got all of the tools and technology in place to enable you to do it.” And at the end of the day, we want to make, just like you said, those 15 minutes with the community members that you serve more impactful and with the option to bring more innovative things to your community than ever before.
And on the patient side, or being a community member, you know, I love all the powerful stories that I get to hear of people who are busy, women who are really busy, and now they look at participating in a clinical trial as even a control patient, as a way to give back, as a way to serve. And most of those stories end with an, “Oh my gosh, I thought I was a control patient, and I actually got diagnosed as a result of my participation in that study because I haven't done anything in my health care over the last three years with COVID” because of all the reasons we all just talked about.
00:22:22
Nasim I think you all highlighted how technology can really be used to facilitate receiving care, getting care, getting better care, facilitating your care at the time that we need. And there are barriers that we have to overcome. And I think that's kind of Christy, your point about that changing relationship.
Esther, you were touching on this. I think those are the elements that we have that we have to work through as a society to be able to move things forward.
00:22:56
Well, thank you all for joining us for this thought-provoking conversation about women and health equity. I want to thank our panelists Christy Dueck, Sarah Matt and Esther Gathogo.
Great conversation around the role of technology and how can we address some of these shortcomings and limitations that we have for women to receive better care. But lots of areas identified where we really need to work together in partnership to address this as we move forward. Looking forward to ongoing dialog around this, and more importantly, action around how we can impact better health for women across the globe. Thank you.
Be sure to subscribe to Perspectives on Health and Tech podcast for more insights from industry experts, visit oracle.com/health or follow Oracle Health on social media.
Summary
It’s essential to prioritize cybersecurity, particularly for healthcare organizations that handle sensitive patient information. With so much at stake, it’s critical to recognize the importance of cybersecurity and take proactive measures to prevent potential breaches. In a recent discussion, two experts from Oracle emphasized the significance of areas such as ransomware resiliency, cyber-recovery, and other crucial aspects of cybersecurity.
Featuring
Hear Them Talk About:
What’s going on with cybersecurity in healthcare today (0:42)
What Oracle Health is doing to address the cybersecurity situation (1:17)
Areas of Focus
What is the threat intelligence in the platform? (1:27)
The need to continuously monitor and detect threats (1:50)
How to allow the business to continue and provide care in the event of an attack (2:35)
Ransomware resiliency and ransomware recovery (2:53)
How to deliver a cyber-recovery (3:17)
A recap of the three prongs that Oracle is focused on to deliver cybersecurity (3:47)
How Oracle can support both clinical and non-clinical systems (4:08)
Notable Quotes
“There’s an incredible amount of scrutiny in understanding what the threat landscape is and it’s becoming more prevalent in healthcare, where it’s an opportunity for attackers to lock in and prevent businesses from occurring where it matters most.” - Waleed Ahmed
“You have to be able to say, not only is my architect resilient, but in the event I do have a cyberattack, can the business continue?” - Waleed Ahmed
“Oracle is delivering in three different prongs. The ability to detect, the ability to assess, monitor, and also provide the capability of bringing the systems back up.” - Waleed Ahmed
Learn more about how Oracle is safeguarding operations with resilient architecture and military-grade security.
Watch on-demand and live webcasts by registering for Oracle Health Inside Access.
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Episode Transcript:
00:00:00:00 – 00:00:00:09 Perspectives introduction You’re listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data, and technology to help improve health for everyone.
00:00:00:10 - 00:00:00:24 Esteban Hi, I'm Esteban Rubens. I’m the Field Healthcare CTO at Oracle Cloud. And we're here to have a quick chat on cybersecurity and health care. I'm joined by Waleed Ahmed. He's a leader on the engineering and architecture side of Oracle Cloud. Welcome.
00:00:00:24 - 00:00:00:25 Waleed Pleasure to be here, Esteban.
00:00:00:26 - 00:00:00:35 Esteban What's going on in cybersecurity in health care today? We've seen so many headlines. There's a lot going on, very high profile attacks. There's a lot of flack everywhere. What's your take on it?
00:00:00:36 - 00:00:01:01 Waleed There is there's an incredible amount of scrutiny in understanding what the threat landscape is, and it's becoming more and more prevalent where especially in health care, where it is an opportunity for attackers to lock in and prevent businesses from occurring where it matters the most, especially after the pandemic that we've come out of right now.
00:00:01:01 - 00:00:01:36 Waleed And it has opened up a great amount of pressure on the organizations to do something about it. And in Oracle Health, what we're doing is we are addressing the situation in a manner of three areas. First of all, is understanding what the threat intelligence is in the platform, understanding threat intelligence and using capabilities from security scientists, and also third party vendors such as CrowdStrike to bring in and assess, assess and interpret what the possible threat areas are.
00:00:01:37 - 00:00:02:07 Waleed Now, once you've assessed it, you need to be able to continuously monitor and while you're monitoring, being able to immediately detect it. So understanding these two capabilities need to exist in an architecture will allow, you know, security leaders within the health space to take a take a relaxing mode and saying understanding that, yes, I have the intelligence and I also have the constant detection and and and monitoring of our of of our architecture.
00:00:02:08 - 00:00:02:34 Waleed So those two parts are there now. It's not really complete unless you think about in the event of an attack, how do I allow the business to continue? We cannot stop giving care, especially in a provider space. So in those type of settings, it's a it's a it's a life or death situation. Right. It's being able to provide critical emergent care immediately.
00:00:02:34 - 00:00:02:59 Waleed Now, to be able to do that, you have to not only think about ransomware resiliency, but you have to think about ransomware recovery. You have to be able to say, not only is my architecture resilient, but in the event I do have a cyber attack, can I allow the business to continue as, as you all know, that a cyber attack, when it happens, there is a crime scene investigation put around it and there has to be scrutiny, investigation.
00:00:03:00 - 00:00:03:30 Waleed So business can come to a halt. If you were able to address by delivering a clean room and at dynamically through the cloud capabilities of Oracle, rebuild a reliable, uninfected environment and provisioning it at a moment's notice, that's where you deliver a cyber recovery, a true cyber resilience that is able to recover in and with confidence and allow the business to continue.
00:00:03:31 - 00:00:03:43 Waleed So Oracle is really delivering in three different prongs. It's the ability to detect, the ability to assess, monitor and also provide you provide the capability of of bringing bringing the systems back up.
00:00:03:44 - 00:00:04:03 Esteban That's crucial, though, whether the rapid recovery so that you can continue operations regardless of what's going on. And what about tiering of the different kinds of systems or clinical non-clinical, things like the EHR, billing? We've heard about things happening around the billing system. We can help with all of those areas.
00:00:04:04 - 00:00:04:15 Waleed Absolutely. I mean we have front line EHR that delivers into a backend payroll that pays critical resources to deliver the necessary needs.
00:00:04:16 - 00:00:05:04 Waleed So with that, we we understand and deliver security in depth. That means we will start at where the data resides to secure that all the way out to the edge. So that that in itself is because we run our oracle help platform on oracle cloud infrastructure. Inherently, it delivers security at the data tier all the way up to data in motion and as well providing key capabilities such as web access, firewalls such as, such as cloud strike capability within a cloud guard, and also with the same tool monitoring and detecting issues on the front line too, all the way in the back end where you're having connectivity between provider and payer in that sense.
00:00:05:05 - 00:00:05:23 Esteban Obviously, we could talk about this for hours and hours. We would love to talk to all of you about this. We are more than happy to have any of those discussions and expand upon them and give you very specific examples. So reach out to your Oracle resources and we can happily get engaged. So again, thank you, Waleed.
00:00:05:24 - 00:00:05:26 Esteban Thank you all and we look forward to seeing you soon.
00:00:05:26 – 00:00:05:38 Perspectives outro Be sure to subscribe to Perspectives on Health and Tech podcast. For more insights from industry experts, visit Oracle.com/health or follow Oracle Health on social media.
Healthcare is ever evolving and new trends and tech capabilities are on the horizon for 2024 and beyond. What should healthcare organizations, clinicians, and patients be prepared for? How might healthcare delivery and operations be impacted? Listen in as two leaders from Oracle and Deloitte Consulting LLP dive in and share their perspectives from industry clouds and AI adoption to burnout, workforce shortages, rising costs, consumerism, and more.
Featuring: Hashim Simjee, Principal, Global Oracle Healthcare Leader, Deloitte Consulting LLP Sarah Matt, M.D., MBA, Vice President of Oracle Health Product Strategy
Hear them talk about:
Healthcare organizations adopting industry clouds (1:30)
Utilizing AI to improve operations, support caregivers, and make diagnoses (4:32)
How AI adoption can help free clinicians’ time, improve clinician workflows, and decrease burnout (6:49)
A recent JAMA study comparing empathetic responses of physicians and chatbots and how AI, augmentation, and telemedicine could help offload clinician workload and address workforce shortages (9:02)
Consumerization of patient care and how tech can help (11:23)
Interoperability, and accurate and accessible patient data’s potential to influence health outcomes for populations disproportionately affected by social determinants of health (14:15)
How to make use of IoT with data from wearables and hospital at home (16:54)
How tech innovation can make a difference in healthcare’s biggest challenges this year (18:05)
Notable quotes:
“You can’t replace the bedside manner, you can’t replace the empathy for a clinician, but you can replace the components around pulling together information and coming back with a reasonable diagnostic that can be done and that has to be reasonable and validated.” – Hashim Simjee
“So what we're really looking at is, as we think about AI and access—we really want to start to think about equitable access and using technology to drive easier access for consumers.” - Hashim Simjee
Learn more about how Oracle is connecting healthcare with cloud capabilities through products and solutions.
Watch on-demand and live webcasts by registering for Oracle Health Inside Access.
Check out Deloitte’s 2024 Global Health Care Sector Outlook.
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Episode Transcript:
00;00;00;11 - 00;00;23;18 Sarah Matt You're listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data and technology to help improve health for everyone. We're at the start of another new year, and I can't help but be curious about what's coming in the health care industry in 2024 and beyond. More specifically, the tech capabilities and trends that are ramping up to support health care delivery and operations.
00;00;23;29 - 00;00;42;20 Sarah Now, Deloitte published a 2020 for Global Health Care Sector Outlook report that shared several key trends that are anticipated to make quite a splash in the future of health care delivery. And I'm excited to dive in and hear more. So with that, I'll introduce our guest speaker with us today, Hashim Simjee. Hashim, introduce yourself a little bit.
00;00;43;26 - 00;01;04;19 Hashim Thanks, Dr. Matt. Great to be here with you. The way to help your practice, primarily focusing on technology and health in the intersection of health care. And I'm responsible for our global Oracle health care practice, including clinical plan analytics, HRA, HCM, ERP. So happy to be here with you today.
00;01;05;03 - 00;01;23;05 Sarah Nice. We're happy to have you. You know, in our last podcast, we discussed cloud tech for health care. And looking at this year's health care predictions, I was really excited to see that in a recent report published by the International Data Corp.. So I see that 70% of health care organizations are going to adopt industry clouds by 2025.
Can you share with us a little bit about the emerging technology prediction and how it aligns with the Deloitte's 2024 outlook?
00;01;29;18 - 00;01;58;08 Hashim Yeah, it aligns very nicely with that. We expect to see AI cloud interoperability as kind of huge, huge upturns in the market with air driving potential savings of $300 billion through 2026 relative to the broader market and think that cloud is going to continue to drive adoption and continue to drive efficiency in the market as well as help to improve access and equity as well.
00;01;59;16 - 00;02;21;06 Sarah So you know, when I think about AI, just in the last year, we've had such a huge exponential increase in visibility use cases, you name it. You know, it was maybe last spring when chatbots really just kind of blew it out of the water. We think about AI to improve operations or support caregivers or do diagnostics, you know, Hash, where do you think it's really going to touch us the most?
00;02;24;25 - 00;03;15;29 Hashim So we see it in a few major areas right in. But think about it. It's really streamlining of administrative tasks, improving overall quality of care. Again, you mentioned access to expanding access to care and really around helping clinicians spend more time with patients. So looking at next-best outcomes, suggesting outcomes, looking at case histories and really being able to consolidate test results and whatnot and allow the physician to spend less time inputing all that information together where the clinician can pull all that information together, allowing for admin tasks such as clinical inventory, or to be able to say, you know what the stock levels are and using algorithmic components to really be able to drive that improving quality of care, really looking at time cost to outcomes, to being able to say, you know what the optimal procedure or so on and what location, as an example, to say, how do we pull some of that together and using all of that information that reside in the facilities today and being able to do that much more automated fashion in in a predictive fashion. And so we think those are probably going to be some of the biggest or option these out there that are going to help.
00;03;48;03 - 00;04;20;09 Sarah That's very interesting. Let's dig in a little bit. You know, IDC also shared some interesting stats around AI and Jenny AI and they estimated that 60% of health care organizations will see a 60% increase in AI solution adoption by 2025. And by that time, just like you mentioned, clinicians, time will free up 15% due to Gen AI. So these are pretty incredible stats considering health care organizations have realized the difficulties of rising costs and they're really trying to improve care, quality and clinician satisfaction. So when we think about improving clinician workflows, quality of life for providers, decreasing burnout. What are your thoughts on how we can really make an impact There.
0;04;33;28 - 00;05;05;26 Hashim Prior in the conversation, Sara, you're going to kill me for this is, you know, one of the one of the thoughts that I've had over the years and I've had this discussion with physician friends is physicians are really an amalgamation of a lot of data. So they are, you know, one of your quintessential as you can't replace the bedside manner, you can't replace the empathy for a clinician that you can replace the components around pulling together information and coming up with a reasonable diagnostic that can be done and that has to be verified and validated.
00;05;06;08 - 00;05;26;08 Hashim And so as I think about it, how do you free up the time for them to be able to pull that information together, being able to utilize that time to spend time with the patient and then being able to be much more in the moment with the patient and not have to do all of the routine things that they historically had to do around filling out notes, filling out paperwork.
00;05;26;20 - 00;05;42;17 Hashim How do you use ambient listening to be able to support that and do some of the other tools that are already in the market or coming to market to better describe the position on the clinician experience and then improve the overall patient experience.
00;05;43;21 - 00;06;09;21 Sarah So when it comes to decreasing paperwork as a provider, I am all for that. No problem. When it comes to helping you with diagnosis. Again, I'm not that concerned about that because we've been using clinical decision support tools for 100 years, whether it's a rules-based engine, whether it's a third party bringing in crisp data. I mean, just prescribing medications, especially in pediatrics, can be really difficult if you're just trying to do it off the top of your head.
00;06;10;04 - 00;06;39;16 Sarah I think where I'm the most concerned is really about the bedside care and the empathy piece. There was a recent JAMA article that was from last year that compared ChatGPT both on its ability to make diagnostic kind of inquiries and answer medical questions. It did great on that. Okay, no problem. Not surprised. But then it also showed that the answers it was giving were more empathetic than providers. Now that makes me a little anxious. What do you think about the empathy gap and how AI could cross that chasm at some point, and perhaps I'm going to be replaced?
00;06;51;22 - 00;07;14;08 Hashim I think, you know, I think the diagnostic element, you're spot on, right? I mean, we to your point, we have been using WebMD or whatnot for well over a decade in your self-diagnosing and now actually putting it into a clinical setting is interesting and important where I think the empathy gap is big cross.
00;07;14;13 - 00;07;53;08 Hashim I think the models are we're training the models to be empathetic and to actually listen. And I think part of it is the clinicians are so overwhelmed with so much when you look at what we had to do with COVID, where the decrease in the number of clinicians who are actually available to support the run through the need for more primary care physicians and whatnot, I think is as a interim step in that is going to be important because then you can start having the clinicians be in the spots we need done and then use at the more general questions and care and still have patients feel like they're being closed and then having that information recorded in in the notes and then using those notes to then further inform the clinician, you know, becomes that virtual loop that you want.
00;08;02;16 - 00;08;27;06 Sarah So I'm wondering if there might be additional ways to help with burnout, because when we think about this empathetic response from AI, now Dr. Matt, the surgeon, when I was working hundreds of hours a week, I admit I was a little cranky. I admit maybe I was living on Rock Star Energy drink and in a dream. But he doesn't get tired and doesn't get hangry.
00;08;27;10 - 00;09;01;15 Sarah Dr. Matt absolutely does. So I'm wondering if I can offer clinicians, perhaps the rest that they need or the time for clinicians to offload some of those smaller tasks, again, that are patient centric, but perhaps the doctors need to do themselves. So I'm interested to see how we start utilizing either a AI-augmented telemed or other ways of doing it, not just for doctors, but for nurses, for other health care workers, or any of the workers, for that matter, within a health care system. How do you think this might address workforce shortages?
00;09;05;00 - 00;09;35;03 Hashim 100%, last year at CVS one of the companies introduced a sensor for the toilet where you can actually pee and it would measure 300 metabolites. This year. There was another century introduced that was looking at breathing and kind of being able to look at what was coming from an oxygen intake standpoint. We look at being able to look at what's on your wrist from a whether it's a Garmin or an Apple or whatnot.
00;09;35;03 - 00;09;56;26 Hashim I mean those are those are devices that are starting to bring together information like nothing else. And all of a sudden you don't need to go to a lab, you don't need to go do different things. You can start pulling all that information together into clinical records and being able to then start offering diagnoses that presentation time, but also present clinician time and frees up lab time.
00;09;56;26 - 00;10;22;08 Hashim It frees up lots of other things when we're actually starting to have these devices embedded within the home in the air, I can start our models can start looking at consuming that data, especially in our models and coming up with a health record that you will never have access to and a much more complete health record. So from that standpoint, I think getting noticed in patient history and all of that becomes a background task which then allows for the commission to have significantly more time.
00;10;23;26 - 00;10;51;14 Sarah So when we think about the patient, we're truly consumers now. And I think that COVID-19, you know, it was a mass trauma for all of us, but it made patients really think about what they want for health care, whether that's comparing prices, self-selecting where they want to go, go get care, especially in the United States. But we think about the patient as a true consumer and we think about some of these nontraditional care models and the importance of patient convenience.
00;10;51;25 - 00;11;24;13 Sarah You know, I'm seeing a lot of focus really on how can we move things to different venues, whether that's my favorite truck that comes to my house every day with my packages not to be named, or if it's getting my care within a retail organization like a Costco or CVS or whatnot. You know, when we think about how this consumerization of patient care is really not just at the forefront, but it's now, what are your thoughts on how either I can help their patients and tech can help their what is Deloitte think.
00;11;25;07 - 00;11;57;00 Hashim So that aligns with our future of healthcare already. So we've seen a shift. And to your point, we don't we don't see them as patients anymore. We see them as consumers in healthcare. And much like anything else, they're looking at the lowest price for the best quality, just like you would with your favorite retailer online. What do you have the ability to start comparing now with price transparency in the US, you're starting to see the ability for a patient to go across multiple hospitals for elective procedures and say, Where am I going to get the best price?
00;11;57;10 - 00;12;23;03 Hashim Understanding the quality of care now that that needs a little bit more elucidation or elimination relative to quality of care versus price. But beyond that, you know, we're starting to see even states with Medicare being able to go out and start doing competitive bids. Now for the first time, Florida recently, as of I think two weeks ago, said they were going to start looking at importing drugs from Canada.
00;12;23;14 - 00;12;50;25 Hashim It was an article out today, I think, in the Journal or New York Times that said Ozempic is about 75% cheaper in Mexico and it is in the States. And so we continue to see kind of this massive proliferation of information and data that's coming out for services that are extremely useful for people. And from a retail perspective, you know, whether you Google or whatever other search engine we're using to go start shopping, we're going to see that significant through July here.
00;12;51;08 - 00;13;21;14 Hashim And it's going to be incumbent on providers to be able to say what differentiates me in the market as a quality of care, as a service, and what is it not offering multiple versions of service. The other thing that we're we've seen significant rise in is medical tourism for elective procedures. That there's a funny name that I recently saw around the backside of a of plane and there's a bunch of guys coming back from Turkey who are being managed up in the Carolinas, essentially said that they were all returning from heart transplants.
00;13;22;05 - 00;13;39;01 Hashim Right. And we're starting to see a lot more of them across the globe going for dental work in India or going to Southeast Asia for some of the medical care. It's a lot cheaper and doing a four-star resort than actually having a full service down here in the States.
00;13;40;10 - 00;13;59;22 Sarah When we think about getting care, whether it's in another country or even just in a different town or just down the street. You know, we're really speaking about the necessity of accurate and accessible patient data and interoperability is really another hot topic in which we've made great strides as an industry, but we still have a really long way to go.
00;14;00;02 - 00;14;14;08 Sarah So I know Deloitte highlights that committing to information sharing has the potential to influence health outcomes for populations disproportionately affected by social determinants of health in particular. Can you kind of expand on this and what you folks have mentioned in the outlook.
00;14;16;01 - 00;14;45;08 Hashim What we’re really looking at is, you know, as we think about A.I. and access and just more generally where we see it as, you know, we really want to really start to think about equitable access and using technology to drive easier access for folks, for consumers. And as costs are continuing to drive higher, how do you continue to manage the access point on that?
00;14;45;28 - 00;15;16;29 Hashim Everybody's got a phone, right? Being able to automate a lot of the tasks that are on that are on a common device that everybody has is really helping. So access is really linked back to or portability is really going back to access. So how do you continue to drive access to information? Use your access to your point around telemedicine and the ability to get care in than during COVID, a lot of rules were suspended specifically around licensing across state.
00;15;17;13 - 00;15;43;07 Hashim We've seen a lot of mobility for workforce that people don't want to go back, people don't want to move back to where they were and their physicians didn't move in. They were still getting the same level of care, if not improved care, because it was easier to get telemedicine from that standpoint. So we continue to see we continue to see access to being able to afford being able to drive that, especially as the costs continue to drive up.
00;15;43;07 - 00;15;47 Hashim And then we're expecting to see the costs in inequality rise to well over $1 trillion.
00;15;48 Sarah That's a ton of money. I don't even know how to fathom that much, to be honest. You know, it's interesting when I think about some of the ways folks have been trying to take care of themselves with or without their doctor. And a lot of the new modern wearables are a very interesting example of that. I remember just a few years ago, having been in this industry for a long time, doctors were very hesitant to bring all that data into the electronic medical record because it was overwhelming at the time and there weren't really great ways to show it was, you know, out of normal to make sure that the right people were notified.
00;16;28 Sarah But I'm really thinking that with more advances in the AI, disability for wearables, which before were okay, now, even with the same data, I feel like we can do a lot more. What are your thoughts on wearables and more of the hospital at home and other ways of bringing patients, not to a doctor's office, but keeping them in their homes and utilizing more IoT?
00;16;54 Hashim So to me, it's where it's where the industry is headed, especially with labor shortages. And I mentioned this earlier with regards to whether it's Garmin or an Apple named in favor of product, that the amount of data that those devices are capturing is incredible and the ability to actually get a full view of the patient is much easier now for a position than before.
00;17;19 Hashim When you took patient history, natural poor technician often admitted they were eating all these sweets or they didn't do their work out or whatnot. But you can't hide from the Apple Watch that's counting your steps or the glucometer that's automatically measuring your blood glucose level every 30 seconds or so, and that you can scan at any time and get that from your Bluetooth.
00;17;44 Hashim And from that standpoint, it's I think it's a much better position because now you can actually make informed decisions, versus in the past where it was you were getting 50% of the information from the patient. And these devices have come down in cost and significantly cheaper to obtain an available library everywhere, frankly.
00;18;05 Sarah Well, I know we're almost out of time, Hash. So fast and furious. Let's think to what your predictions are for the next year. What do you think are healthcare's biggest challenges and how is tech innovation really moving the meter? Give me two examples.
00;18;20 Hashim I think Staffing and the ability to support staffing is going to be huge. We've seen inflation coming down and cost of care is continuing to still hold steady. If not, why so? And staffing is going to play a huge part in that. And then the other big challenge is continuing to access and how do you make the information more accessible to consumers to improve the overall patient experience.
00;18;45 Sarah All right, I'll take it. Well, Hash, thank you so much for joining us today from Deloitte. It has been an absolutely wonderful discussion.
00;18;55 Hashim Thank you. This is great. Really appreciate the time talking you as well.
00;18;58 Sarah Be sure to subscribe to Perspectives on Health and Tech podcast. For more insights from industry experts, visit Oracle Dotcom Slash Health or follow Oracle Health on social media.
It’s no secret: healthcare systems are overburdened—could cloud capabilities really provide some of the needed reprieve? Could the right data presented at the right time reduce costs and improve operations, ease the administrative burden on clinicians and payers, and help improve the patient experience? Two experts discuss use cases on cloud-enabled intuitive assistance, streamlining and vetting data, how cloud-enabled technologies are benefiting the whole patient experience, and more.
Featuring: Michelle Flemmings, M.D., industry executive director, Healthcare North America Cloud Infrastructure
Sarah Matt, M.D., vice president of Oracle Health product strategy
Hear them talk about: • What’s going on in the healthcare industry right now (0:24)
• Using cloud and other technologies to improve workplace experience and retain healthcare workers (1:15)
• Challenges and concerns when moving from rules-based applications and tools to more predictive forecasting and AI (2:54)
• Working with clients going through the transition of bringing together disparate data sources separated by geography, organization, privacy, and security (4:27)
• Harnessing cloud capabilities for clinical trials (7:24)
• How to build trust around privacy and security for cloud and AI—and how cloud can be a secure mechanism to bring forth that trust (10:05)
• Opportunities in leveraging the cloud for healthcare (14:24)
Notable quotes:
“I think that cloud has a great availability of information, but it also has the functionality whereby it can hopefully look at the system overall, if it's dialed in right, and then predict what's necessary and then take out the rest of the chaos. You know, taking in the signal and taking out the noise.” – Michelle Flemmings
“Now with the potential of AI using thoughtful implementation to support our providers from burnout, empower our patients to lead their healthcare teams, make those right decisions using trusted information that's fit for purpose, it changes the entire landscape.” – Michelle Flemmings
“We need to make certain that we're not replacing that trust that has been in the provider relationships so long and then got compromised when we did start going digital. There's an opportunity here to rebuild that, and magnify that, and still broaden our ability to care for more patients.” – Michelle Flemmings
Learn more about how Oracle is connecting healthcare with cloud capabilities through products and solutions.
Watch on-demand and live webcasts by registering for Oracle Health Inside Access.
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Episode Transcript:
00:00:00 Dr. Sarah Matt You're listening to Perspectives on Health and Tech, a podcast by Oracle where we have conversations on creating a connected healthcare world where everyone thrives. I'm Dr. Sarah Matt. I'm the VP of Oracle Health product strategy. And with me today, I have Dr. Michelle Flemmings from our OCI team. So, Michelle, I know we've been hearing a lot about cloud capabilities for healthcare. Can you get us a bit of an overview of what's really going on in the industry right now?
00:00:24 Dr. Michelle Flemmings Well, Sarah, thank you for that question. I have had the pleasure of meeting with a lot of our clients and being at several events recently and top of mind is cost containment especially with the economy as it is, and the cost continuing to rise. Second, a very close second, is achieving and maintaining operational efficiency that will help support that cost containment.
00:00:44 Things around process improvement, throughput, driving patient outcomes, improving quality performance as well. And then I think, honestly, the one that really surprised me the most is road mapping around the implementation of AI and wanting to establish the right partnerships in order to know that they're doing it in the right way.
00:01:03 You know, in a race not to be last, they got to be they're busy road mapping but they also have to assess the readiness for change. And I think that's where I'm having the best conversations.
00:01:15 Sarah Matt Interesting. So we talk about cost containment as a start. I know that over the last couple of years, especially when COVID hit, we had huge issues with not just supply chain but the supply of our workers. So we think about utilizing cloud and some of our technologies to improve not only the experience of our workers, but how do you keep and retain them? What have you seen as really effective mechanisms, especially in healthcare?
00:01:37 Michelle Flemmings Oh goodness, that is a double-edged sword. Having worked with a lot of systems and in a lot of digital tools that support our care of patients, you have to be careful in the balance. You don't want to be very disruptive in the way of inset and alerts, but you also don't want to overload with minutia and tab hopping and logins and so forth.
00:02:01 Where the sweet spot is is intuitive assistance and uplift for productivity as well as insight speaking specifically around things such as items that occur in the background. So I'm seeing a patient, they know that this patient has a hip fracture and automatically, based on the fact that the patient weighed 125 pounds and is, you know, five-feet-three, this patient will need this size of prosthesis and it automatically taps out two supply chain to identify the location and availability. Those sorts of items that are intuitive and in the background and I don't have to touch another tab are important.
00:02:38 Additionally, clinical decision support—the right information at the right time that doesn't disrupt my brain processes and my thoughts, because anytime a provider is interrupted, an opportunity for omission and errors.
00:02:54 Sarah Matt So I know when I see patients—I still do charity care on the side—it is a very difficult job for all providers to keep up with the latest and the greatest when it comes to new literature, new guidelines, and that most hospital systems are doing whatever they can within the application space, whether it's their electronic medical record or otherwise, to assist with some of those areas.
00:03:15 When we think about moving from rules-based applications and tools to more predictive forecasting and AI, what do you think are some of the challenges and concerns that health organizations really need to think about?
00:03:31 Michelle Flemmings Wow. Overload of information we have that now we need to prevent it. Especially when you start doing predictive. If we're going to do that, we need to be very dialed in on our resources, our sources of information and eliminate duplication. As well, make certain that it's not just raw data that you're bringing in, and then you leave it to be sorted by the individual.
00:03:54 So any ability to bring in items that are useful that are already vetted somewhere in the system and provide the right-size solution is going to be key. It can't just be everything that you bring in. I think that cloud has a great availability of information, but it also has the functionality whereby it can hopefully look at the system overall, if it's dialed in right, and then predict what's necessary and then take out the rest of the chaos. You know, taking in the signal and taking out the noise.
00:04:27 Sarah Matt When we think about large healthcare organizations or even small healthcare organizations, especially United States, cloud is becoming a lot more necessary, if you will, because we're moving from a lot of extremely siloed on-prem installations of whatever it might be into an extremely connected environment and the HIEs of the past and the present may not give you enough of what you're looking for from a connectivity perspective. What I'm seeing a lot, and I'm wondering what your thought process is, is that payers, providers, even pharma, are all moving to systems where they're actually utilizing PaaS (Platform as a Service) to bring together some of those disparate pieces, whether it's in a data lake, a data lake house, whatever you want to call it. But they have so many different systems that are either separated by geography, separated by organization and separated by privacy and security, and they're trying to figure out the best ways to bring that disparate data together. How are you assisting some of those clients that you've been seeing in moving through that transition?
00:05:27 Michelle Flemmings Absolutely. We start with, for lack of a better word, an audit of their inventory. What do they have? What do they utilize and where does it sit? How is it connected? Is it connected in a manner that works for you now? If so, great, we won't mess with that. But if it's not connected and you need to go ahead and log into something else or open up another platform, that doesn't work.
00:04:49 What we then go to is examine and evaluate in partnership with our clients. What else are you trying to achieve? What are the near misses that you have now that you're experiencing and are frustrated or struggling to capture? And what is your Nirvana?
00:06:06 And then we make a path with them from those starting from that basis. It needs to be end-to-end, is honestly where I think that we need to take our clients and go with them for success. It needs to be everything that starts with the patient walking in the door. In the case of the provider and how do we do dispositions that makes sense and prevent readmission.
00:06:26 In the case of payer, how do we get the first-time right rate for claim submission, but then also put automations that are thoughtful, meaningful, and impactful in that the prior authorization process and in the payment process. How do we help them to remove the, now primarily retrospective, review of claims for potential fraud, bring it into more contemporaneous—then in cases where possible, how do we bring it to being anticipatory? So we're identifying patterns that would be consistent with possible fraud?
00:06:58 And then for patients, how do we help our clients to provide for patients a whole health patient experience that empowers them with the right tools, helps them make the right decisions for themselves and help them to guide their care team to support those decisions so that they can have their best outcomes and they can live their lives and return back to life, as opposed to being sick and in the hospital?
00:07:24 Sarah Matt You just mentioned a number of really interesting use cases. I think the most important thing I found is that every institution has to decide what is their priority, what is the most important use case they're going to focus on, because if they're focused on clinical trial access as opposed to retain providers or leveraging the cloud for patient insights, that would start perhaps in a different department with different data elements, etc.
00:07:49 You know when you think about kind of the cloud capabilities making a huge difference for some of these areas, let's pick on clinical trial access for a second. You know, what are some really interesting ways you've seen folks really harness the cloud for those capabilities?
00:08:04 Michelle Flemmings That's a great question. As a physician, my personal experience was that you can't know everything, and things change so much in that capability. So we have to be cognizant of the volume of data, but also the need to remember that these things exist and that's very difficult, especially when you're dealing with large numbers of patients and you have a huge workload.
00:08:30 I believe, and there are ways of bringing in that information as the patient goes through the journey. My sister had breast cancer; ended up with bilateral mastectomy. The last thing on her mind when she was in the hospital was anything about clinical trials. She was so concerned about the possibility of passing away while in the hospital. I think it would be very important to, before she even gets admitted, we know when she's coming in, let's start putting out some of the information about clinical trials to our patients with instructions and opportunities to speak with a nurse navigator or physician to walk through the process. Let them know what's available when their mind is able to be settled and concentrate on this. Give them expectations for when they're in the hospital about helping to make some of these decisions and maybe even starting care while they're in that hospitalization, to not delay any further treatment.
00:09:24 With the use of items such as conversational Gen AI, rather you could give instructions and more education, preparing them for the conversations in the hospital. As well, I think giving them some insights about what the capabilities are, even in a broader expanse than just their facility, maybe they through referral or maybe they through alternative care options bringing that technology to the patient is something I think that they deserve in a manner that meets them where they are. For their level of their level of understanding, but also gives them the opportunity then to connect back with their trusted source of care for questions.
00:10:05 Sarah Matt In the healthcare space we have done a lot of things maybe not so great over the many decades and hundreds of years that have led up to today, and many groups are still leery of the healthcare system. Add on to that a layer of technology and AI that most people cannot even begin to grasp. Understand because it's kind of a black box in a lot of ways.
00:10:27 How do you think folks are thinking about cloud technology and AI? I know there's still lots of concerns about privacy and security. You know, when you think about those areas and how we can assist in building that trust, what are your thoughts on how cloud can actually be a secure mechanism to bring forth that trust?
00:10:47 Michelle Flemmings First off, I think that we need to put more information out in the places where our patients and future patients are looking at data now. We need to make certain that the right information is out there on the most popular websites where people do their searches before coming into the hospital and then change their perspective. We need to talk about the security. We need to let them know that their information isn't going to end up on some social media channel or and also portray to them and let them know that we are deserving of their trust because we do this very well in other industries, especially in the financial industry with regard to security. I think that's first and foremost.
00:11:26 We also, though importantly need to build the trust of the providers. There are several that are in fear of their jobs disappearing because they'll be replaced by the machine.
00:11:36 Our patients sometimes believe that the machine is going to have some sort of a decision-making mode that is going to tell the physician you know I'm no longer worth taking care of. I'm a dead-end so no longer give any time to my care and instead devote your time to someone else.
00:11:54 So starting with the right information about the security, especially your personal health information, securing and demonstrating capabilities along with the health information exchanges and platforms. Pulling in that information into portals, driving patients to that portal with trust at the provider level and at the individual organizational level is going to be important as well because a lot of folks, it's going to be seeing and feeling and experiencing that's going to build the trust.
00:12:25 Sarah Matt That's a great thought process there, Dr. Flemings. I know this has been a really interesting conversation. I want to ask one more question. Let's end this one on a positive note. So when we look forward, what are the opportunities that you're the most excited about in leveraging the cloud for healthcare?
00:12:41 Michelle Flemmings Oh, wow. Oh, wow. Yeah, shame this is the last one. Truth is, I am most excited about all things AI. I am a child of the 60s. And for me, I remember when I had my first little calculator—I thought that was mind-blowing.
00:12:57 Now with the potential of AI using thoughtful implementation to support our providers from burnout, empower our patients to lead their healthcare teams, make those right decisions using trusted information that's fit for purpose, it changes the entire landscape.
00:13:15 Honestly, I do believe, especially when you talk about productivity and augmentation of workforce, that has to be top of mind. How do we put that into our workflow so that it helps and doesn't hinder and that it also doesn't overload with extra information?
00:13:32 I think that is really where it lies. Maybe it also considered tapping some of the information that's in pre-hospital systems. I believe as an ER physician that the bedside is where the care starts and that sometimes that bed side happens to be at the roadside. We need to use AI and our capabilities to bring in that information because sometimes that is key to decision-making for the physicians.
00:13:54 Also, I live in a very, very rural area in southwest Colorado. I think that GenAI and virtual care should go hand in hand and that we can help better support our patients who live in areas distant from hospitals, especially at smaller hospitals that’s closed—extend that care, improve outcomes, maybe bridge some of the gaps between healthcare and retail sources that are trying to now invest in healthcare. Make it better, fortify it with some clinical expertise from some of our organizations, but utilize the infrastructure that's already in place, maybe, especially if you want to consider this: primary care and behavioral health. I think we can make huge inroads in those and provide care, right where people live.
00:14:40 Sarah Matt I can't agree with you more. I think for me, I feel like we're really at the precipice. We have so many tools that are at our disposal. The data is now becoming more clear. How can we bring things together and effective means throughout healthcare organizations to really gain that value. I think over the last decade or so, we've been inching along from a digital perspective, inching along, we'll say, journey to AI. Here we are, I think now every healthcare organization is going to have to decide how they want to interact with it, how they're going to prioritize it and how we're going to keep the focus on the patient.
00:15:17 Michelle Flemmings Totally. In closing, with focus on the patient, I would offer two recommendations. When it comes to AI, I believe that going slowly is actually going quickly. We need to be iterative like you said, about where we go and how we institute and how we implement, because sometimes those small and impactful wins will build the security and the belief in the system for the overall organization and also drive that to our patient.
00:15:46 Second, I think that we need to make certain about that, keeping the human in healthcare, in all portions of healthcare. We need to make certain that we're not replacing that trust that has been in the provider relationships so long and then got compromised when we did start going digital. There's an opportunity here to rebuild that, and magnify that, and still broaden our ability to care for more patients.
00:16:11 Sarah Matt Doctor Flemings, thank you so much for joining us today.
00:16:14 Michelle Flemmings Thank you, Sarah. It was my pleasure.
00:16:16 Sarah Matt Thank you all for joining us on this very exciting podcast discussion. Please be sure to subscribe to Perspectives on Health and Tech podcast for more insights from industry experts, visit oracle.com/health or follow Oracle Health on social media.
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You're listening to the Oracle Maven podcast, where we bring people together from the veteran affiliated community to highlight employees, partners, organized actions and those who are continuing the mission to serve. Welcome to the podcast. I'm your host, Chris Spencer, and in this episode I'm joined by our guest, Colin Young, senior director of Operations with Axios, reviewing one's activity and experiences to assess the effect or value of the outcome is what we often do with intention.
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Sometimes without even realizing we're doing it thinking about how we performed, interacted with others, or maybe didn't do enough are important. What's more important is how we manage those thoughts, where we regulate what we think, how we feel, and what we need to do. There are specific techniques that help. Focusing on the mental and cognitive aspect of our performance is a key component in the complete package of personal optimism.
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Today, we're talking reflection and regulation. Listen in as Colin and I continue our discussion journey of how EXOS delivers value towards helping you get ready for the moments that matter. Remember to take time to care for yourself. We have all we need to become the person we want to be. So let's remember how to connect with others with sincerity and genuine intent.
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As we continue the mission to serve. Thanks for listening. We hope you enjoy this episode and please remember to check in on your buddies and family. Collins Contact details are in the podcast description and you can always find me on LinkedIn Call and what's going on.
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Good morning. Good afternoon.
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Hey, it's great to have you, Colin. You know, I know we've we've got a pretty good schedule going on. And for everybody out there listening, we've got Colin Young here, who is the senior director of operations within XO. And the topic for today that Colin will speak to is focused on reflection and regulation. And in the scheme of everything that we're putting together, how we broken down on these components, it's important that we we cover the whole gamut and make sure that we're talking about how to think about things and consider what you're going to do moving forward.
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So the depth will come from Colin and everything that he's going to do to explain it. So Colin.
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So you know, you're expecting depth. All right. You know, I usually hang out with my son in the shallow area, but I'll do my best to dove in with you today.
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So let's go. Yeah.
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So, yeah, so I'm really excited to be here. My background for, for those that probably haven't heard my name is in coaching in general. I started as a strength coach, like many folks who have been with EXOS for a long time. Right. We were athletes performance a long time ago. And have since rebranded and expanded. And so I started coaching at a young age.
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I was involved in sports in high school and college, played college baseball and it was a small school. So oddly enough, I ended up being our strength coach my senior year. So I got my first kind of like dabble into that world before I was even out of there. I was an extra science and sports science major, so I really enjoy the coaching aspect of it.
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Went on to join athletes performance in its infancy, and we expanded and now we coach in a lot of different realms. We coach in the workplace, we coach incorporate fitness facilities, but still rooted in that kind of like athlete's background. Which I always very much relate to myself. So now what I'm doing is shifted kind of pretty dramatically into more of the mental and cognitive performance side of things, which is still just coaching with a different lens.
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And it's just been incredibly rewarding and an educational and just a ton of fun for me to to shift my lens to this new space and understanding how much overlap there is and being able to bring my experience there. So direct director of operations and say a whole lot with the title, you know about it. Yeah, that's, that's where I'm at now is operating a lot of our programs that are designed around mental and cognitive performance.
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How can I get the most of myself? How can I get the most out of my team? How can I find the most kind of rewarding aspects of what I do and who I am as an individual each day? And that's that's my focus day to day now.
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Got it. Now, I appreciate that backdrop but what position in baseball?
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I was an outfielder, and then my senior year I got to D.H., which is like the best position in baseball, especially playing ball in the Pacific Northwest. You know, it's not exactly your season starts in February. It's not the greatest weather. So it's like, all right, I've been playing defense. I'm a step by the space here. Like, you guys are great, you're doing great out there, and then go up and hit, you know, three to five times a game and come back and said so yeah.
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I got to say, because of all the great dishes out there, do you have walk on music? What was your what was your song?
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We we did oh, man. You know, I think I was always and we'll maybe get to this. Maybe we can dissect some of my own internal workings here. I didn't I wasn't always and still to this day, not like super high volumes go, go, go type music, whether it's hip hop, rock, whatever it is. So my senior year, my walk up song was Fortunate Son by CCR.
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Oh, there you go.
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It's just kind of like, hey, I'm already hyped up enough to get to the play. Like, let me call myself down a little bit and kind of get zoned in. So yeah, that was my walkup song my senior year.
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I like it. Yeah, that that paints the picture.
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There you go.
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All right. So so about when did you did you join XOs?
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Yeah, I did my internship in 2008 it was where I started. And then after that I worked mostly with baseball players, obviously with my background a little bit with our combine prep program that you may or may not have touched on in previous episodes with Anthony or John or whomever. So mostly baseball guys. And then I see it, the longer, longer I've been with the company, the more it feels like a little hiatus.
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It was on a paid internship. They didn't have anything for me. I went and got a job elsewhere. I did some coaching at a charter school coach, football and baseball and soccer and everything from like kick and giggle all the way up to two more competitive spaces. And then was a director at the YMCA for a few years at a very young age and three apartments, our wellness membership and aquatics department.
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Oddly enough, they just kind of kicked it to me. So and then came back full time with the company in 2011. So and then since then I've held a ton of different roles. Like I said, I started as a strength coach when I came back and then kind of shifted into management and then have shifted and since into this kind of mental performance space.
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Got it. And so what's the attract into this mental space that we're talking about and what is, what is reflection and regulation mean to the layman?
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Yeah. So first question kind of what, what attracted me to the space? Yeah, my my other major in college was psychology. So that was always kind of around. And oddly enough, I really enjoyed my time at the Y Looking back on it, maybe I didn't enjoy it at the time, but it was it was such a rewarding experience for me to see in the grand scheme of things.
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The YMCA is is not known for its progressiveness and excellence in the movement and fitness space. However, if you look at and think of some of the benefits and some of the things of the YMCA as well, it's community and that society just kind of so I really delve into the psychology of how to build a community, how to get someone and many someones to start a habit and keep a habit that's positive for them.
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So you learn things like motivational interviewing, you learn things like group dynamics, just kind of on the fly and you see the attitude there. And so that really helped propel my, my interest in it and have since taken that and apply to both to my own teams that I manage within EXOS as well as with the content that we create for this kind of mental and cognitive performance space.
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So it's always kind of been around for me. It was kind of accelerated with with the YMCA at the time with that concept of community because you know, we say all the time you could have the best program in the world. If someone doesn't show up to do it, it doesn't matter. And so it's like, you know, they get results from people just because people enjoy being there and coming back.
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So it's like, how do you how do you pair the two to really get the most out of someone, get them coming back and then, man, you're really dialed in for one of their and so now, you know, we're where we're at with mental, mental and cognitive performance. It's it's really, really interesting to kind of apply that in the workforce.
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And certainly for me in my own personal endeavors as well, and that's where I loved it was probably a favorite topic to talk about a reflection and regulation and what does that mean? So reflection is really just can I observe myself and my surrounding sands critiques sans ego, right? Can I do it without judgment? And then regulation is can I go through that observation again?
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Can I then determine what is required of my own performance and those around me eventually? But typically, most of us spend a ton of time on on our own endeavors. Can I understand? Hey, here's the situation. Here's what I understand it to be and here's what's required of me as far as my own performance. And then that regulation gets into a bunch of different kind of wires that we could certainly go into a little bit.
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So a lot of people love to just jump into regulation. It's also like yeah, so we can get into it further, but a lot of people love regulation. I kind of have spent an equal time in both, and I think you need both to maximize performance.
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Hundred percent immediately. I'm applying it, I think, well, in the past episodes I've probably bored people with how I look at it for me. And when I'm talking to those of you that have this specialization, the principle is if I'm getting ready to go out and do something, I'm thinking about me and kind of translating and what you're saying as far as observing the surroundings, hey, my I'm recognizing my physical limitations or the abilities.
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And so I'm going to go out and I'm going to run the mountain or I'm going to run up this hill, I'm going to run or I'm going to walk or I'm going to do something. I'm trying to trying to figure out whether or not I'm capable of doing it with the things that I know and then trying to anticipate whether I know what I should know.
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Right. And so I'm just trying to figure out, is that is that kind of the idea between the reflection is you're kind of going through the cycles of your own mind to figure out what you want to do, where you want to do it and how you want to do it.
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Yeah, I think, yeah. You summarized it really nicely. You know, there's there's so it starts with kind of drive, you know, we do something calls about a values exploration and kind of understanding what's driving you both in a positive and a negative. Like that's one thing we call kind of the shadow self a little bit. You know, a lot of people call the subconscious whatever it is, you know, we are as human beings are built to kind of go on autopilot.
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And a lot of those things aren't necessarily helping us kind of get to that next level and kind of grow and do what we want to do. And so understanding what those drivers are, you might have a conscious driver of like consciously, you and I probably sit here and go, oh, I want to be as healthy as I can be.
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I want to go train every day. I want to train hard, I want to eat healthy, I want to be present with my family. I want to do all of these things right like consciously I'm going to say, of course, we're gonna be like, yeah, you know, and but subconsciously, like, why don't we every minute or every hour of the day and every day of the week and every week of the month and month of the year, why don't we always strive towards doing those things which we consciously say Yes, that's what I want.
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That's a driver. And that's that's kind of the, the, you know, one of the spaces you can take is, is what is truly driving me. And that's, I think, a great place to apply kind of what we would look at as a reflection. We break reflection down in the name. Reflection is a little bit misleading because it's things it kind of leads you to think retroactively.
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And we look at it. You could also use a little bit of a synonym towards awareness and that word might spark things a little bit differently. So we break it down into three spaces. There's proactive and retroactive certainly. So like proactively to your point of doing an assessment, say I'm going on a hike or whatever, doing that assessment, like where am I truly at doing that self assessment?
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What do I need? You know, the proactive space and then retroactive would be going out. Like how did that go? How did I feel? What did I experience? What did I do well? What could I have done better right there? Those kind of bookends of it. But then that holy grail of what we categorize under reflection or awareness is real time awareness.
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And that's where reflection in regulation or awareness and regulation or almost an inextricably linked. It's also probably the most challenging place to get to when you're trying to upskill in this space of self-awareness for a variety of reasons. So yeah.
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Is that just so I'm clear on that one? Because when you said it, I started to smirk. Now I'm running, I've gone through the first two things, now I'm running and I'm imagining how much this running sucks. Is that that part where it's the real time awareness to where you're going through it and then you're paying attention to what's happening while it's happening?
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Where am I off there?
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No, no, not at all. Yeah, that's that's part of it. Again, within that awareness we've got, we'll break it down for we love turning things into systems. I think that's what's allowed XOs to be great is you've got phenomenal, you know, the coaches and, and string coaches and within each section and with their specialties all over the place.
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And that knowledge end up staying very tribal in nature. And with them learning what access has been able to do really well with systematize a lot of this and have it makes sense and this really makes sense to me. So it's like within real time awareness. There's three things that we're looking at. What you're definitely talking about is, is there's the kind of what we got into receptive like physically what's going on within my body at that time there's emotional awareness.
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So like what emotions are my experiencing? Like am I, you know, okay, this is difficult. Like in what how am I tackling that? Am I frustrated? Am I, you know, looking at is is as some type of challenge, you know, whatever it is, right? What emotions are bubbling up for you? And then from kind of like a thought pattern awareness.
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So, you know, what am I thinking? Where am I going with this? Can you this is where like meditation comes into play really really as a tool to teach this, to help you observe your thoughts, like, oh, wow, this is really challenging. Do I immediately go to school I can take this on? Do I have the self-efficacy to say this is challenging, but it's doable.
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I can do this. I know it's difficult. I've done difficult things before. I'm going to do it or is like, I want to give up I hate this. This sucks. Whatever it is, right? There's no right or wrong within that space, but just being aware of which way you kind of go in that space. So like what are my emotions?
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What are my thoughts and what's my body telling me doing in the space and being aware of that in real time can can be really challenging yeah.
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That that's, that's where I think the discipline in those things is probably I'm assuming that the focus here is to get you to understand there's phases of realizations. You broke them down seemingly in chunks of threes, which is a great start, but it's procedural and you've planned for that. And this this is all again, to reiterate, this is all part of the reflective component.
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We haven't gotten to the to the regulation part or has that kind of mixed into each.
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Other it certainly ties into it, absolutely. You know, so emotions, right? They'll they're going to bubble up. So they might as humans were designed with these crazy, amazing survival mechanisms. And so what happens is in real time, we take in a stimulus from our environment or even from our internal environment. We might remember a stressful thing in our body is really good and our brains are really good at making something that either hasn't happened or or has happened and isn't happening to us anymore feel very real.
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And so the stimulus could be from our external or internal environment. It bubbles it up. And then our brain the thing is that stimulus goes through the amygdala, which is at the base of our school, which is the emotive center of the brain after it's also interpreted by the central nervous system that allows us gets us ready for movement.
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So we're already already ready to move or act and we're already feeling things before that stimulus makes it up into our frontal cortex or frontal lobe, which is where our executive function and that's where we actually cognitively and consciously can start to internalize what this is and so that's designed to help us react very quickly to a life threatening situation.
00;17;35;23 - 00;17;56;17
Right. Which was there were a lot more of those back before modern medicine and before our stressors. So it's like these stressful environments. Right. Cool. So my brain is automatically looking at some shaking bushes and interpreting all these different signals, sounds, smells, like it's all those things to say, hey, is that just the wind or a squirrel or is that something a little bit more threatening?
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And so I perhaps chose to act it helps us with through emotions, ties it to previous experiences of, oh, it was a squirrel. Cool. You know, I might, you know, by the time he gets to the frontal lobe, I can say, yeah, that's not not a big deal. Or is it like, oh, that really resembles a time where I had to get out of Dodge.
00;18;17;03 - 00;18;44;23
And so it's we're already like anxious. We're already are our senses are heightened and we might already be a little bit frightened or scared. And so when we get a stimulus that is is sent to us there and the stimulus has shifted, now it's I get you know, someone triggered me because I they said something in a way that someone in a toxic past relationship said something or I had a bad manager or my manager isn't great in there.
00;18;45;00 - 00;19;21;08
They're, you know, sending an email in a certain tone and so that starts to trigger. And our body interprets that and our brain interprets then it ties it to a survival mechanism. Oh, if I lose my job, I can't provide for my family. You know, I'm not going to be able to to make things happen. So it bridges this huge gap for us, even though the stressors of change, the response is the same and so we're already fighting against this uphill battle of of the survival mechanism when we have especially stressful or interpretative stress for stimulus into our environment.
00;19;21;08 - 00;19;42;03
And that's where the awareness piece can come in being aware of, hey, I'm feeling a certain way. I'm feeling this physical sensation of, oh, I'm sweating or my, my stomach is upset or my heart is racing. There's the interceptor oh, my thought patterns are going, oh, I'm not very good at my job because I screw this up or whatever it is.
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And then now being aware of that, then we can start to look at regulating in that that space. And then we can start to say, Okay, wow, this anxiety is built to help me survive. Right? There's a purpose for it, but it's not serving me right now. So then how do I, in this case, down regulate my body and my brain to help me come to a more we'll call it productive outcome for this.
00;20;12;29 - 00;20;28;28
So that's a long ways. I say it's really challenging. Why it's so challenging to both be aware in the space and also why regulation is so challenging to put into play and why you have to have both. Because if you don't know what you need to regulate you're not aware that you don't. It doesn't matter. We can be all the tools in the world.
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You're not going be applying it properly. You're going to be trying to eat a bowl of cereal with a pitchfork or something, you know?
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So it's a big old ball. Remember those?
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Hey, you know what? Now I'm kind of hungry.
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So for charter school, come in front of the TV on the table.
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That's right.
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Captain Crunch for days right. So I'm so thanks for that. I mean, so there's a couple of things with this to kind of just figure out where it applies in some scenarios. So, I mean, you talked about some workplace scenarios, talked about says anywhere in life, you just basically assessing when you're when you're awake and you look around, things are happening all the time.
00;21;08;19 - 00;21;25;03
You've you've regulated it right now. I know you're going to get to that. But just kind of for for all of us trying to figure out what bookmark where we are. You regulated it in a way, too, where you've now understood it enough to say threat, not threat is that we're saying, right, I'm getting up I'm walking here, no big deal.
00;21;25;16 - 00;21;43;24
But if I'm now same scenario or I'm getting up, I'm the environment's different. I'm in my tent in the middle of nowhere where I already know that there's threats of bears and wildlife and things like that. I'm getting up needing to go walk over there. I'm more alert. It's different because you're regulation hasn't yet the experience of that particular scenario.
00;21;43;24 - 00;21;54;21
So you're developing these patterns that we can maybe simplify our self-talk, right? You're trying to speak yourself through these scenarios. Is that kind of a good gauge for that situation of what you just said?
00;21;55;13 - 00;22;00;18
So you're talking about like in an actual scenario where you're out in the wild or, you know.
00;22;00;27 - 00;22;05;13
Kind of piecing it together and like this reality component of everything that you broke down?
00;22;05;25 - 00;22;32;20
Yes. Yep. So we talk about all the time. Biology will always trump psychology so, you know, self-talk can be great in more of a proactive space, you know, and saying, hey, look, we know that like talking and rewriting even more so helps ingrain things in the brain to to help us overcome. So if you're for example, you know, like your hike or you run or whatever, right?
00;22;32;21 - 00;22;53;27
Like if you get to a point where you're actually anxious or you're kind of beyond just kind of walk all of the norms of of, you know, our emotions and our reactions, psychology and psychological tactics like visualization and self-talk, they get a little bit diminished returns to the point where they may not and may not be be helpful.
00;22;53;27 - 00;23;11;23
And that's where we use things like breath quite a bit to help us use our biology to try to change the psychology. There's this interesting feedback loop, and I'm pointing between my brain and my body if we're on audio here, right? It's like we think of it as like brain and body, but like it's all the nervous system.
00;23;11;23 - 00;23;31;26
It's all it's all linked together. But there's this feedback loop of like my brain in how I thought we talked about how you can relive past experiences, and that will trigger physical response, could be anxiety, could be joy, could be whatever, and then vice versa. We can actually have our bodies say, look, we're in a safe space. You know, we don't have to be stressed out here.
00;23;32;04 - 00;23;51;27
And that's where you can kind of calm yourself down or downregulate. And so we use things like breath, we use things like vision, natural light, movements are all wonderful strategies to help us kind of up or down regulate, because there might be times where a lot of us we're talking about downregulation, there's stress and we need to kind of bring ourselves down.
00;23;52;05 - 00;24;13;08
There's also like, ah, afternoon low, I'm a little lethargic or I didn't sleep well and I need to be kind of dialed for this coming up. I mean, that's one thing why we talk so much with our special operators. The community that we work with about sleep is like, Man, you're starting this huge deficit. We know you're going to be going and going out at different times.
00;24;13;08 - 00;24;32;27
It doesn't matter. You're on the different patterns but sleep when you can because it's always kind of a huge hole to dig out of. But then and you might need to upregulate, Hey, I know I'm going into a dangerous situation. I need to be dialed. I want to have some of those things like adrenaline going through my body because it will focus my attention and energy and I will be more alert.
00;24;33;07 - 00;24;54;07
So there's kind of like, okay, turn the dial up. Turn the dial down. That's where a tie is to reflection. Hey, what do I need in this space? And we really try to use especially for Downregulation, but also for up using using biology to help us out and so that's where like breathwork comes into play is a fantastic strategy both directions, so.
00;24;54;17 - 00;25;21;02
Got it. Okay. Thanks for that. Yeah. So yeah, the second one I was going to you answered already because then I was thinking about movements. If you're, if you're injured and because of in the rehab process, you're having to address that injury the hesitation, the reluctance to do it because you had the pain receptor is recognizing if I do that, move my knees going to whatever I think my knee is going to do, whatever kind of the same thing, different scenarios.
00;25;21;02 - 00;25;23;29
I guess it's just kind of how you're imagining things. Yeah.
00;25;24;12 - 00;25;47;12
Totally. Yeah. I mean, what we're talking about, the ability to regulate the ability to kind of get ourselves up to do the hard thing to to, you know, find space and clarity in a stressful situation, very much like especially there's trauma, emotional trauma, like physical trauma. You're going to avoid it. That's a shadow driver that you may or may not be conscious of for a long period of time.
00;25;47;26 - 00;26;19;02
And so kind of digging into it in the right way and within the right boundaries is going to be critical and doing it over and over again, practicing that just like with rehab. Right it if you have a phenomenal surgeon, put everything back to back together, if you don't kind of get those reps in of putting it through the range of motion strengthening, you know, getting that confidence and like that's oftentimes a huge portion of rehab is like guys physically how the capabilities to come back from an ACL.
00;26;19;11 - 00;26;37;28
But they just it's so tough to trust it there and you've just got to get the reps in. You know, I can change direction, I can change direction, I can change direction. And then when it comes into that kind of chaotic space like on the field, then you don't have to think about it. You don't want to have to be think about it's like you make a make it unconscious.
00;26;37;28 - 00;26;59;21
And so it becomes a habit. And so it just like with that emotionally and regulating, putting yourself in those situations, and creating that tolerance to stress is is is really helpful or understanding, you know, putting the reps in to understand that awareness. Like that's where meditation like a lot of people hate it. A lot of people struggle with it.
00;26;59;22 - 00;27;17;02
Our CEO, you know, that's my I'm on, I'm on. I work with her a decent amount and that's my goal is to get her to just, you know, spend, you know, 5 minutes a month, you know, just taking, you know, stillness practice and kind of bringing the attention inward with no distractions. That takes practice and you can get better at it.
00;27;17;27 - 00;27;35;09
And so, yeah, the injury analogy is, is perfect of, hey, there's something that's driving us in that I'm working around. If I can kind of keep digging into that, keep get those reps in, I'm going to be able to regulate more when there's a little bit more stress. I'm going to be able to understand myself and how I'm going to respond in those situations.
00;27;35;15 - 00;27;40;07
And therefore make it a more productive outcome. So, yeah, it's it's spot on.
00;27;40;24 - 00;27;59;08
Got it now. Thanks for that, doc. I mean, I now I know what you mean where you're going to bounce back and forth when you try and explain one of the other. So I think we covered the reflection part and we've dabbled in the regulation component and let's dig deeper.
00;27;59;20 - 00;28;31;24
Yeah. So I'd say one of the big tools we use is a good representative of up and down regulation is, is breathwork. So we're trying to like, okay, let's make a tangible call and cool. You know, you're going off on bushes and stimulus and you know, things are going to harm me. What I like is it's kind of sounds a little bit out there, but like, okay, let's make it tangible the first thing from a reflective component that we can do is take a few moments proactively.
00;28;31;24 - 00;28;50;03
What is the day going to demand of me? Okay. Hey, I've got a podcast that I've got to chat about and try to sound smart for a few minutes. I want to make sure that I do the right things proactively to get myself ready for that. And then afterwards I'm going to say, Hey, well, why didn't, you know, get feedback from Chris and all that kind of stuff?
00;28;50;03 - 00;29;08;06
And so cool. Did you know, how did I do with that? And then real time I got to make sure, hey, what is my, my current state, my getting really excited talking about this stuff? Do I need to maybe slow my voice down a little bit? Right. So there's there's that component to it. So finding that space, I think, is really crucial.
00;29;08;06 - 00;29;28;14
That's one thing that we straw like that. We we see that high performers struggle with is everybody wants to do more, give me more stuff to do. And we love to focus on being. And so when we're tired, that's where, you know, again, I'll come back to the concept of stillness or meditation or mindfulness, whatever you want to label it.
00;29;29;18 - 00;29;54;29
Some we work with a lot of SEO is a lot of athletes, a lot of special operators. Just give me more to do. I give me the perfect exercise, give me the perfect meal plan, give me the perfect strategy. But when you just say, cool, here's what I like you to do. I would like you to sit alone with no distractions in your eyes closed for 5 minutes and people almost like recoil from that.
00;29;55;16 - 00;30;20;14
But what we're doing is as we're getting better at understanding what's going on internally, and be depending on what your protocol is for your meditation, you're learning to bring your info, your focus and attention to where you want it to be. And it just I know it sounds maybe, I don't know, base level, but think of just truly how powerful that can be throughout your life.
00;30;20;14 - 00;30;41;16
Like when I want to focus and bring my attention to something that's important to me, man. Like, I want to be perfectly I got a two and a half year old, like the days and months are flying by. Do you know he's talking? And I just I still remember and he was just, you know, a little tiny nugget and like, I don't want to I don't want to be distracted from that.
00;30;41;16 - 00;30;57;14
And it's, you know, there's everything is is designed to distract us from it, thinking about what happened at work, our phones, you know, everything going on. What do I have to do tomorrow? But, man, that is what's really important to me right now. And I'm going to do my best to make sure that I can focus that. And so you have to practice that.
00;30;57;22 - 00;31;16;28
You have to practice not getting distracted and so, you know, that's that's for me what's most important. But for others, it could be, hey, I really want to dial an interview. I want I've got to get up for again, our special operator community like I've got to be perfectly dialed and focus for this mission because it is literally life or death.
00;31;16;28 - 00;31;32;26
Right? So like imagine being able to to bring your focus and attention where you wanted to be. So I'm from a kind of awareness standpoint. I think that's that's a great place. Do you have to kind of the book ends of the day for the proactive and retroactive of those are great places to start there a little easier, right?
00;31;32;26 - 00;31;54;05
You're a little further removed from, you know, the real time kind of chaos of of life. And then, you know, the meditative component or the stillness practice, there's a bunch of different ways you can do that, but just sit alone and with with nothing, no distractions for a minute, for 2 minutes, for 5 minutes. And and that can be really, really powerful.
00;31;54;05 - 00;32;24;16
So that's from a reflective or awareness component and then from a regular literary component, especially in an in the midst of kind of needing to get myself up or bring myself down. We love starting with breathwork, and it's really the simple strategy is the longer your exhale is especially and compared to your inhale, the more signals it's going to send to your brain that you can be in this rest and digest state.
00;32;24;20 - 00;32;54;26
So if I have a nice like an elongated exhale there, that's going to start sending signals that, hey, anxiety isn't really what I need here. I don't need my brain and my thoughts to be going a million miles an hour. I just can be calm. And then it's quite the opposite. Like forceful, short exhales you think of like things like athletes or like I always think of like a bobsled or like they slap their legs and then go, right.
00;32;54;26 - 00;33;17;01
They're actually up regulating so we have, you know, a ton of different protocols that can go as long as 25 minutes. They can almost put you in a bit of a euphoric state. When you get there. Yeah, but just like short, you know, power breathing, that kind of stuff. Like is, is kind of the, the simplest way to break that down and utilize your breath.
00;33;17;01 - 00;34;03;09
So most people, I would say throughout the day, breathe too quickly and put themselves into more of this kind of fight or flight stress response chronically which does not serve us. And so most people, we could benefit from slowing our breathing down just in general. And for those that are like colony loss me and meditation but maybe, you know, I want to do something to help myself, breathwork and even just rhythmically breathing without having a crazy protocol, but just focusing a little bit more on that exhale, rhythmically breathing for 5 minutes a day has actually been shown to have the same chronic benefits as far as like morbidity, blood pressure, heart disease, all those things like in
00;34;03;09 - 00;34;24;05
a positive manner in the same way that like meditation can. So like if you're like, I don't really want to meditate, but hey, maybe I'll try that. You're just focusing on my breathing and bringing attention there that can be really beneficial. So you don't you don't need to meditate to calm yourself down a little bit. But there are certainly other benefits of meditative practices.
00;34;24;10 - 00;34;28;02
So yeah, it's so that there's a bunch there.
00;34;28;14 - 00;34;28;23
Yeah.
00;34;29;09 - 00;34;37;07
But so I wrote down some things as you were going through that stuff and so that the kind of the that stuff, I don't mean to undermine what you did.
00;34;37;08 - 00;34;41;12
Oh no, it's totally fine. My wife feels the same way. So yeah, that's about what I do.
00;34;41;20 - 00;35;05;03
It's, it's you know, the, the do more and doing right. And then it's the, it's the, the, maybe it's not what I believe so much is. It is what it could be but I'll say I believe it to be this way as it's conditioned. We've been led to believe that we have to in order to influence or persuade others that were effective.
00;35;05;19 - 00;35;28;14
I'm, if I'm doing more than they'll look at me as I'm being bringing some value. Right. And so I think there's this value component is started in this kind of play games, at least in my life stage, to realize what the value is that is actually giving me the belief that if I do more or if I do X, then I'm going to get the things that I'm expecting.
00;35;28;14 - 00;35;57;29
So the expectations that come from it. And so when it comes now to the the to the flow of thought to believe, when you say, oh, you want to do that, let's start with 5 minutes of breath work immediately. Is it is it do you find that it's because you're telling them something that's so far off when they thought they were going to hear from you as far as what the steps would be on how to get to that high performing out element of breathwork?
00;35;57;29 - 00;36;13;05
What are you talking about? So it's the resistance of what I've what I've been conditioned to believe or understand as far as what is necessary to become a high performer. Never thought about breathwork. Is it more of a resistance to what they've been conditioned to understand or is it something else?
00;36;13;29 - 00;36;34;19
Yeah, you know, that's a good question. It's certainly a little bit different for each for each of us like. Well, again, that goes back to drivers, right? You know what is what is driving the need for this accomplishment, this need to do more? A lot of it is. And this is where we talk with a lot of our clients about a lot of it is not necessarily time management either.
00;36;34;19 - 00;36;56;29
It's about attention and focus management and what you want to do. And so people just want they they want to just add more and really that the limiting factor to their their long term, especially their long term performance, not just performance in general, but like we very much about sustainable performance, right? Like we want you to have a long career in the NFL, in the MLB.
00;36;57;04 - 00;37;12;10
We want you to come home from all the missions. We want you to be able to you know, continue to achieve what you want to in the workplace, where whoever we're working with, it's all about sustainable performance. And yeah, in the short term, doing more can give you more. You get you get more ROI, right? It's a media.
00;37;12;10 - 00;37;34;18
It's also like the same thing of like, oh, why people more people will exercise till the cows come home and CrossFit are the day away and all that kind of stuff. But it's like really the limiting performance to what you want out of your fitness right now is just nutrition. And that requires restraint and that concept of restraint is, I think, where people really, really struggle.
00;37;34;18 - 00;37;58;20
And so, you know, it could be they've been brought up with our culturally or from family, from childhood. A lot of the stuff that we work with is, is, is your stems from that. But, you know, for whatever reason, it's like I've got to hustle culture, right? That's also like media. It's like hustle culture, hustle culture. And and so it's slowly starting to kind of shift back a little bit.
00;37;58;27 - 00;38;31;27
So we're fighting against those expectations. But I think it's that element of restraint that people are really challenged with. It takes it sounds weird, but it takes more willpower for a lot of folks, especially people who are achievement oriented. Like you don't get anything back right away from sitting along with your thoughts for 5 minutes, just like you don't really get anything back from eating one vegetable bowl like you had a bunch of vegetables over time and suddenly, wow, there's a lot of these wonderful benefits, body composition, blood pressure, you name it.
00;38;31;27 - 00;39;02;04
Right. So, yeah, it's it's this we deal with that concept of restraint and helping people to understand the value that like doing less now over the long term is going to pay dividends because you're not going to be burnt out and tired all the time. From Go, go, go. And because you're going to be more present in the time that you do go and do things, you are more efficient at it because hey, you're suddenly more understanding of how you operate internally.
00;39;02;09 - 00;39;06;03
And so you can navigate a lot more different scenarios of that makes sense.
00;39;06;11 - 00;39;45;08
It does 100%. I'm recalling what and I probably everybody that we talked to, whether it was John or Jan or Anthony I'm Stefan and now you it's implying we'll just call it as a break taking a nap. I mean, been talking to John so you're saying is taking a ten minute nap is going to be beneficial because you're going to reset and the optimization of time is instead of staying awake for 24 hours because you believe it's going to give you an opportunity spend more time doing more but you're going to be slower at it less efficient and probably risk injury in some capacity whereas if you took you know in this case context the ten minute
00;39;45;08 - 00;40;06;27
break or nap, you can refocus your body can kind of reset, recalibrate. This is kind of the same thing it sounds like is what you're doing is the same level of decision making that goes into deciding to do something. The restraint component is to say the temptation to feel like you got to do more is the same thing.
00;40;06;27 - 00;40;10;27
Is the temptation is to not take a break. Would you say.
00;40;11;13 - 00;40;14;08
On vacation, spot on, spot on.
00;40;14;23 - 00;40;35;21
The view out there, they're saying that your work life balance is an element of understanding this and that it's tough for whatever it starts with you. It sounds like this is what directing is internalizing, which is the friction part reflection. It's your self. If you understand how you can self-regulate you're saying the biology, I guess, is probably the best way to say it.
00;40;35;21 - 00;40;46;21
Through these practices, these techniques, you're going to see the benefit that can be comparable to allow you to make decisions differently to know what sustainable even means, because you'll feel it over time.
00;40;47;18 - 00;41;08;08
Yeah. And this this is where for me, it's been really rewarding to dove into a lot of the stuff and putting it into practice for myself because this isn't just for sports, you know, you see the application there, right, of understanding your own abilities and, and having that ability to regulate and calm yourself down in stressful situations, you know, fourth quarter scenarios, that kind of thing.
00;41;08;08 - 00;41;29;15
Right? You're going to have an edge over your your competitor right? In the workplace, you know, the ability to kind of have that that ability to stay calm in stressful situations, to be more creative when it's, you know, when the necessity arises to be able to problem solve because you've created that space for yourself to be able to do that.
00;41;30;09 - 00;41;48;24
It's going to be critical and certainly just to be a better partner. Right? Oh, I I'm in an argument with my partner. Right. It's it's it's you know, I think what a lot of folks will say is you're never going to find that. You're not going to argue with just the ability to to come to a common understanding and commitment.
00;41;49;07 - 00;42;10;00
It's not snapping and saying something that you regret later. Right. Because you said, oh, I'm I recognize this internal state. I understand what I need. I can call myself down and I can then respond, not react. And so, you know, it's it's the ability to bring that to whatever scenario. And yeah, it's it's less about going and finding.
00;42;10;06 - 00;42;26;08
I mean, yes, they're breathing protocols. But you said like just breathing rhythmically is going to give you a benefit, right? You don't need to even have a perfect protocol for you. And just creating a space for yourself is is going to be really just so powerful. So.
00;42;26;20 - 00;42;37;06
Yeah. Yep. Okay. Well, we scratched the surface, clearly, but anything else to touch on before we close?
00;42;37;24 - 00;43;16;05
Now, I just I hope that people take some space after listeners for themselves and just see what happens. Be curious about what's going on in inside, and that's just going to help you in so many ways. You know, it's, it's and can be really rewarding because you're just being more present with yourself, with those around you and then, you know, finding those strategies that work for you once you understand where you need find those strategies and you're going to find that, hey, I'm, I'm at my best a lot more frequently when I'm able to do that.
00;43;16;05 - 00;43;23;19
So yeah, go ahead and just take some time and try doing nothing for a minute. See what happens though.
00;43;24;03 - 00;43;26;03
You're doing nothing is doing something. Yeah.
00;43;26;13 - 00;43;26;22
Yeah.
00;43;27;01 - 00;44;02;00
I've learned that when it comes to decision making, when we don't take a position on certain things and then when we sit and lay on the grass and look at the sky and you actually imagine how nice it is to do that and you forget so. Mm. So thanks for that call and thanks for your time. I will, I will say this and take an opportunity to challenge anybody listening then, you know, 30 days try for 30 days, you know, a minute, 5 minutes a day for 30 days journal it just, you know, jot down how you felt before you did it and then when you made the decision maybe jot down why you made the decision
00;44;02;00 - 00;44;24;18
to do it. Try it 5 minutes breathwork. If you're not completely sure what that means, you know, find out from EXO's, go on site, find out what's available, maybe Google some things do do whatever it takes unless you have a resource immediately available where you can ask that person Hey, how do I do this? Find out, do for 30 days and let us know what you get back, you know?
00;44;24;19 - 00;44;30;19
So Colin, if you're up for it, if, if anybody wants to reach out and connect with you, what's the best way?
00;44;31;18 - 00;44;52;08
Yeah, I'm not much of a social media warrior, so probably I'll throw my email out there. See Young at Axios dot com and I always love talking shop. I always love talking about how we can help you. And if you want to understand a little bit more about how to reflect and bring awareness and regulation, your space man all talk your ear.
00;44;52;15 - 00;44;52;25
So.
00;44;54;10 - 00;44;56;28
Got it. Appreciate your call and thanks for everything you're doing.
00;44;57;14 - 00;44;58;00
Yeah. Thanks, Chris.
00;44;58;17 - 00;45;00;08
All right, everybody, keep moving forward.
Mental health remains a significant area of concern in healthcare, especially after the pandemic. Universal screening tools, such as suicide risk assessment, have become a vital resource. One of the best ways to normalize mental health screening is by integrating it into your clinical electronic health record (EHR) workflow. However, with the influx in risk assessments, is your staff confident and prepared to handle the needs that arise? And does your organization have the infrastructure required to support those needs?
While telehealth has alleviated part of the burden for providers, it has also exposed many ways technology can create barriers to care, especially for communities who are already at a disproportionate risk for suicide and addiction. So, how can we better coordinate care across the illness-wellness continuum? Join Danny Gladden and Dr. Sarah Matt as they discuss the progress and opportunities to support mental health and improve suicide prevention.
Guests:
Danny Gladden, director of behavioral health and social care, Oracle Health
Dr. Sarah Matt, vice president of product strategy, Oracle Health
Hear them talk about:
Learn more about Oracle Inpatient and Outpatient Behavioral Health solutions
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Episode Transcript:
00;00;00;00 - 00;00;30;09
Danny Gladden:
You're listening to Perspectives on Health and Tech, a podcast by Oracle, where we have conversations on creating a connected healthcare world where everyone thrives. Hi there. I'm Danny Gladden, clinical social worker, director of behavioral health and social care here for Oracle. Dr. Matt, so glad you are here.
Dr. Sarah Matt:
Thank you, Danny. I'm so excited. You know, when it comes to suicide prevention, I think there's so many problems that we could talk about, but I think there's also solutions and things we can do next.
00;00;30;16 - 00;01;06;28
Danny:
So I'm excited that we're talking about this topic today. Yeah. And, you know, I think we've made some great progress. And I say we as the collective, we myself, I'm a clinical social worker that practices in mental health services. I've actually ran one of the National Suicide prevention lifelines, but suicide prevention takes all of us. And so, you know, I'm actually just curious, you know, you're a physician—think about your preparation into sort of medical school and residency.
00;01;06;28 - 00;01;26;15
And you know what does what did your preparation look like as a physician assessing for and treating suicide risk?
Sarah:
So I went to med school a long time ago, I will say, But when it comes to training, it was very traditional. So four years of med school. And then I did my residency in general surgery and my fellowship in Burns.
00;01;26;17 - 00;01;56;05
So I'd say that when you think about structured learning for mental illness, it was pretty scared. Most of it was around inpatient mental health services. So that's the rotations that we did in medical school. Now there was the small bits and pieces you may have gotten on your primary care rotation, but it really wasn't a focus. Now today are unclear how the clinical rotations are going and how the medical schools have changed their training.
00;01;56;12 - 00;02;19;17
But I would say that for the generations of doctors that are in my age category, it definitely wasn't something that was highly stressed.
Danny:
Yeah, you know, in the last couple of years, I get invited from time to time to come in and speak to first or second year medical students, particularly on the subject of suicide assessment, suicide prevention, collaborative safety planning.
00;02;19;17 - 00;02;58;19
And I, I think that structurally we've come a long way in normalizing the assessment of suicide risk. We have built it into much of our clinical workflows. The Joint Commission has guidance on how on how we assess for suicide risk. But I think even maybe where there is some competence that's been gained, there's still a gap in competence, particularly because of our own fears around, oh, if I ask someone about their suicide risk, what will I do with the information they provide me?
00;02;58;19 - 00;03;28;02
And particularly I think about our community access hospitals it at 2 a.m. who are sort of dealing with folks with limited resources, limited specialty consultations and whatnot. And so we celebrate universal screening tools such as the Columbia Suicide severity rating scale or many other really great evidence based, validated tools. But I know that we have a long, a long way to go.
00;03;28;02 - 00;03;54;21
And so as we think about September Suicide Prevention Awareness Month, we think about the physicians and the nurses and those and quality and compliance who are working to manage risk within a within a hospital health system. What are you seeing best practices from a technology perspective in how folks are leveraging technology to assess for and prevent suicide?
00;03;54;24 - 00;04;18;18
Sarah:
So it's hard to say best practices because I think we can still do a lot better. A lot of times everyone at the administrative level of a hospital system recognizes the importance from a regulatory perspective, from a compliance perspective for universal screening for suicide. And a lot of times this kind of shows up as an extra forum for the nursing staff on intake and things like that.
00;04;18;20 - 00;04;37;14
I think some of the things that are missing are the why and the importance. And so in a system where nurses, doctors and all the rest of the staff are highly strained, sometimes it's difficult to do another form. The other thing I had mentioned is that a lot of times this burden is put again on medical assistance and nurses.
00;04;37;21 - 00;05;02;21
The providers rarely do these screens themselves, and I think that oftentimes they might not know exactly what the screening is or how useful it can be. So for their patients, where they may have a potential and or a diagnosis to have some sort of depression, anxiety, etc., there's things that they can use. There's tools that are available and they may not have all of those at their disposal.
00;05;02;23 - 00;05;57;11
Danny:
Yeah, again, back to the community access hospital or the Alaska village that's using a health aide, for example. I think about that 2:00 in the morning assessment that the sort of mandatory requirement in policy to assess for suicide risk and the patient sort of reporting some level of suicidal thoughts and the provider, the nurse, the health aide in Nome, Alaska, wanting desiring to do what's best to keep the patient safe, but also have limited resources to be able to, you know, get that get that individual true specialty care.
00;05;57;13 - 00;06;47;01
And so, you know, celebrate universal screening. But also worry about actual the what happens on the other side of a positive screening. Is it possible that we are unintentionally over hospitalizing folks with the best of intentions or over incarcerating folks with the best of intentions to keep to keep patients safe and to keep the community safe because of lack of available responsiveness from trained mental health professionals who can a dig deeper into assess, assessing and understanding is there a true lethality risk or is this someone who has what we might call morbid ideation?
00;06;47;01 - 00;07;18;00
You know, if I didn't wake up tomorrow, that would be okay. But no, I'm not actually going to hurt myself. And then also the ability to build collaborative safety plans. Right. We don't get to draw blood or run an X-ray to know someone's risk, right? We get to ask a bunch of really intrusive questions and then the intervention is not is not often, particularly for suicide risk, medication in real time or a cast or another medical device.
00;07;18;02 - 00;07;47;26
It is a really intense creation of a collaborative safety plan that's a usable tool for the for the patient to leave the hospital to help them recognize their own triggers and to help them utilize their own resources, their own social network, for example, to mitigate that risk. And so I celebrate universal screening and I worry about the infrastructure that's behind it.
00;07;47;26 - 00;08;21;23
And let's just say, Dr. Matt, the you know, someone does have a risk of suicide or other psychiatric disorders that need to be treated. We have an infrastructure that doesn't have enough available beds and that folks often get housed in emergency departments, get housed in municipal jail cells. At times they get housed in med surge out of a desire to keep them safe.
00;08;21;23 - 00;08;42;24
Sarah:
I'm curious what thoughts you have kind of on the current state of mental health delivery. So I think that, you know, as we go past universal screening, we've just screened all these people, just like you mentioned. Now, what is the problem? And I think you're right. In a lot of environments, everything from primary care to pre-hospital to inpatient.
00;08;42;26 - 00;09;06;07
The next step is the hard part is the hard part for the patient who may need extensive therapeutics as well as medication. But from a provider perspective, what do you do next? If you are in a small rural hospital, you may not have access to a psychiatrist in the middle of the night. It might be that that personally comes every couple of days.
00;09;06;07 - 00;09;24;12
It might be that you do a televisit in the morning. What do you do for that patient in the meantime? And you may not have a lot of options. So I think you're stuck in a lot of ways. If you're in a primary care environment and you have a patient that has immediate needs, what are you going to do?
00;09;24;12 - 00;09;49;27
How do you help them? You have to send them to the hospital because there's nothing else you can do. It's outside of your scope. And then if you're on the streets, you know, from a pre-hospital perspective, having been an EMT in the past and still as a firefighter now in a volunteer situation, when people are on the streets having a crisis, it can be really hard for civilians to say this person is dangerous or this person is having a mental health crisis.
00;09;49;29 - 00;10;14;16
And I think that what we found is there's just not the resources to come and assist those folks. We have firefighters, EMTs and police officers. That's basically we have on the streets. We don't have an army of social workers like yourself, Danny, that I can deploy to help people who really need it. Now, I know there are some cities and some municipality that are doing more in that area, but we could do a ton more.
00;10;14;16 - 00;10;49;28
It's really hard, though. So what I'd say is I think that universal screening or again, providers, nurses all doing the best they can, they're seen issues, but they don't have a lot of options for the next step. And I think that's problematic.
Danny:
Yeah, for sure. You know, in many cities across the country, law enforcement, paramedics and EMTs, firefighters are are getting some really great training crisis intervention, training to help be able to sort of manage a mental health crisis and in real time.
00;10;50;00 - 00;11;17;12
But the scale of all of us need some variation of mental health first aid, which is available for free in most communities to be able to, you know, for getting CPR training and first aid training. Mental health first aid training is also an essential part of being able to being able to work with folks in real time and in our communities.
00;11;17;15 - 00;11;46;28
You mentioned telehealth visits, and I was, you know, drawing on my extensive experience in Alaska. And you know, we have sort of a paradigm shift through COVID by which much of behavioral health services that occurred within the four walls of a clinic or a hospital have now transitioned to the home. And that's so exciting. It was it was it was a big shift.
00;11;47;00 - 00;12;19;24
But I also think about folks living with severe mental illness, often who share other social vulnerabilities, such as such as housing insecurity, such as technology insecurity. And I'm wondering if you can talk a little bit about tech equity and sort of the division between the advancements in technology and the delivery of care and those who are also left behind?
00;12;19;26 - 00;12;43;28
Sarah:
Absolutely. So I think it's interesting, Alaska is a really good example of where telehealth has been immense in the ability to reach patients. But I think we take for granted that you can have, I'd say, health care deserts in a big city, health care deserts in the middle of the country, health care deserts, not just in a third world country per se, but right here in places that we go every day.
00;12;44;01 - 00;13;12;11
And a lot of that has to do with socioeconomic issues. But what does that mean from an access perspective? Do our patients have Internet? Do our patients have cell phones? Do they have smartphones? Do they have enough data on their data plan to utilize that smartphone for a television as an example? So when it comes to mental health, there's a whole slew of new commercial offerings for tele psychiatry where they even will prescribe medication.
00;13;12;11 - 00;13;33;28
And that's a really interesting option, especially when we think about the stigma around mental health services. And so getting more people to be served is wonderful, but it may be disproportionately serving certain populations. The populations that their only Internet is at the library are not going to be able to have a televisit in the middle of a public place.
00;13;34;01 - 00;13;58;24
Those folks that have a data plan that maybe isn't so large, are they really going to use our data plan to have a televisit? Hey, that's a tough one. And the other piece is really around different kinds of people. It's even harder for children and teens to get the services that they need because pediatric psychiatrists are far and few between at baseline.
00;13;58;27 - 00;14;28;07
And again, a lot of people, especially minors, but in teenagers need help. They need lots of different things, but they're not on their own insurance. They don't have the ability to do a lot of things someone who's not a minor can actually do. So I think it makes it even more difficult.
Danny:
Yeah, And I'm thinking on the other side of technology, I don't I don't know if you know this data point, but in the United States, only about 30% of behavioral health providers are using some sort of a digital record.
00;14;28;07 - 00;15;16;26
And so not only are we sort of pre info sharing and pre and are off, we there's really no consistent way in which mental health data is collected and shared. And so it means each time someone is having a mental health crisis or needs to present for a new mental health provider, they have to start from scratch and retell their entire story, answering intrusive questions from a provider who is a stranger to them. And I'm super excited about, you know, from a policy perspective, I think I think there's some there's some great work happening in the United States to sort of encourage and push providers towards a digital record.
00;15;16;26 - 00;15;54;00
And I'm sitting in London right now where the NHS has a mandated that mental health providers move that are part of the mental health trust move to use have a digital record. And I think the more we can sort of use what are now traditional technology tools in the delivery of mental health service says the better we'll be able to paint a true picture of a whole person as far as care is delivered and folk can be shared.
00;15;54;03 - 00;16;32;00
One treatment plan that covers hypertension and diabetes and depression and anxiety. And so I certainly am excited about the direction we're going. I'm wondering, as you know, we probably have a couple of minutes left here. If you see anything on the horizon that that's exciting from you or from you from a technology perspective.
Sarah:
So I think now, especially in a post-COVID world, consumers are demanding more and ultimately it means there's more solutions for folks to obtain mental health services, whether psychiatrist, counselors, you name it, in the palm of their hand.
00;16;32;03 - 00;16;56;16
Now, again, we mentioned there might be some equity issues there for sure, but at the same time, there's so many folks who may have access to a cell phone as an example that could really use that assistance. So I think that the advent of a more consumer focused, patient centered experience is helping there. And with these new digital consumer grade solutions, it means we're digitizing behavioral health, even if it's from the intake part.
00;16;56;16 - 00;17;28;07
For a patient that's half the battle. As a primary care provider now in chronic care management, it's really hard for me to have a new patient come in who might be an immigrant who does not have documentation, to have someone who lost their insurance. All these different problems at the charity clinic where I work to help them in their journey, because if I had documentation of what their issues had been and how they'd been treating the past, my scope of practice includes depression, so I could definitely help them with some therapy and some medications.
00;17;28;10 - 00;17;54;01
But my solo practice doesn't include things like bipolar as an example, so how can I get them to the right people? But if it's not documented, that's really difficult for primary care doctors in particular.
Danny:
Yeah, such a great point. No doubt we are moving into what I would call the techno, you know, the technology age for mental health and social care service delivery.
00;17;54;01 - 00;18;27;18
And that's, you know, from a from a consumer perspective and the quality of applications that are making their way into the market. But it's also from available free available community resources. And I think maybe we can just close with this for our US listeners, there's available 24/7, the National Suicide Lifeline in the last 12 months. It's gone from a gone from a 1-800 to a three-digit number that that all you have to do is remember that number is 988.
00;18;27;20 - 00;18;55;14
It's available for you in your community today. It's available 24/7/365. It's available for you to be anonymous if you so choose. It's also available for you if there's someone that you care about and you're trying to figure out how best to help this person out; the folks who answered the 988 number are happy to sort of talk through with you how best to help someone that you care about get connected to resources.
00;18;55;16 - 00;19;18;05
Unknown
When you dial 988, our veterans have a have a special have a special option to talk to someone who is understanding and committed to veterans-specific topics. And there's also Spanish speaking. There's also a Spanish-speaking prompt or a prompt for our LGBTQ+ listeners. And that's just in the United States. I know we have listeners from all over the world.
00;19;18;07 - 00;20;05;27
Most countries have some sort of a national Suicide Lifeline phone number. So September Suicide Prevention Month couldn't be more lucky to spend some time with you. Dr. Matt, thank you so much for sharing your expertise and experience with our listeners.
Sarah:
Absolutely. Thanks so much for having me.
Outro:
Be sure to subscribe, get Perspectives on Health and Tech podcast for more insights from industry experts, visit oracle.com/health or follow Oracle Health on social media.
As part of the No Surprises Act, healthcare systems must now provide comprehensive good-faith estimates for the cost of care—both from their own organization (relatively easy) and from outside providers (much harder). Listen to industry leaders Seth Katz, University Health, and Josh Mast, Oracle Health, discuss with Jodi Busch, Oracle Health, the impacts of good-faith estimates on health organizations and how to use this phase as an opportunity to streamline workflows and better prepare your teams for the next iteration of the No Surprises Act.
Featuring:
Seth Katz, Vice President of HIM and Revenue Cycle, Finance, University Health
Josh Mast, Director and Product Regulatory Strategist, Oracle Health
Jodi Busch, Senior Director of Financial Alignment Organization, Oracle Health
Hear them discuss:
An overview of this year’s iteration of the No Surprises Act (1:16)
How have these changes impacted safety net hospitals/organizations? (3:36)
How are schedulers at hospitals/organizations handling the increased duties of working good-faith estimates? (5:05)
Was it difficult to gain internal buy-in from your staff for these changes? (6:57)
Have you had any issues sending the good-faith estimates back to patients in the allotted time? (9:39)
Are there penalties for non-compliance? (10:59)
How does the enforcement discretion potentially impact the overall process? (13:29)
Where are you at in terms of combining providers inside and outside of the organization? (15:06)
What has been the response back from patients regarding good-faith estimates? (16:10)
What's coming next? (17:29)
Notable quotes:
“We have to remember that we work in healthcare to help take care of people and make them better and that the No Surprises Act, price transparency, information blocking are good things for the patients.” – Seth Katz
“At the end of the day, this is about trying to get patients and consumers information prior to receiving care so that they are better informed.” – Josh Mast
The podcast currently has 250 episodes available.
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