Perspectives on Health and Tech 

How CAMH is Advancing Mental Health Through Innovation and Social Justice

Listen in for a timely conversation in recognition of Mental Health Awareness Month and National Nursing Week. In this episode, Dr. Gillian Strudwick from The Centre for Addiction and Mental Health (CAMH) and Danny Gladden from Oracle Health discuss how mental health care is evolving, and how CAMH is advancing care through the dual lenses of technology and social justice. Learn how AI tools like Oracle Health Clinical AI Agent are easing clinician workloads, how CAMH is using data to drive impact, and why framing mental health as a social justice issue is key to helping the CAMH team deliver more equitable and compassionate care.

Featuring:

Dr. Gillian Strudwick, Chief Clinical Informatics Officer, The Centre for Addition and Mental Health

Danny Gladden, LCSW, MBA, Director, Behavioral Health and Social Care, Oracle Health

Listen as they discuss:

o   The Centre for Addiction and Mental Health (CAMH) background – 2:45

o   Mental health care viewed as social justice work at CAMH and examples – 5:00

o   Technology innovations at CAMH with a human-centered approach – 9:30

• • Wearable devices and the impact they have on research
  • Repetitive Transcranial Magnetic Stimulation (RTMS) treatment
  • Evidence-based apps and the integration of these into clinical care processes
  • Optimizing EHR use and exploring the opportunity to share mental health notes in Canada

o   CAMH’s perspective on AI technology and its potential impact on clinicians – 18:25

Notable quotes:

“Mental health is social justice work.” – Dr. Gillian Strudwick

“To be able to deliver compassionate care in this day and age, we have to be innovative in our use of technology.” – Dr. Gillian Strudwick

CTA:

Learn how Oracle behavioral health solutions combine real-time, clinical data from across each patient’s unique healthcare journey and how Oracle is working to reduce the documentation burden on physicians and elevate the patient experience with the Oracle Health Clinical AI Agent.

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Episode Transcript:

Intro  0:00  - 0:29

Welcome to perspectives on health and tech podcast brought to you by Oracle Health. In this series, we have conversations on creating a seamless and connected healthcare world where everyone thrives. Let's get started.

 

Danny 0:30 – 01:44

Welcome to perspectives, Oracle Health and Life Sciences podcast. I'm your host today. Danny Gladden, I'm a licensed clinical social worker and general manager of behavioral health and social care here at Oracle Health. As we step into the month of May, we recognize Mental Health Awareness Month, a time to raise awareness reduce stigma and highlight progress in mental health care. I'd also like to give a special shout out to our nurses across Canada and the US as we celebrate National Nursing week. Thank you for your unwavering dedication and compassion. Social workers and nurses make great teams. Today, we're honored to be joined by a leader in mental health care innovation. Please welcome Dr. Gillian Strudwick from CAMH, the Centre for Addiction and Mental Health, Canada's largest mental health and addiction teaching hospital and one of the world's leading research centers in its field. So, Gillian, welcome. Before we dive into big topics here, can you introduce yourself and tell us a little bit about the great work happening at CAMH.

 

Gillian 1:45 – 03:47

Thank you, Danny, and thank you for the opportunity to be a part of this great podcast. I might break this into two sections. First, I'll introduce myself, and then I'll tell you a little bit about the organization that I'm fortunate to work for. I'm Dr Gillian Strudwick. I'm a registered nurse, and I've worked primarily in mental health clinical settings here in Toronto, Canada, and also in other parts of Canada and internationally. Currently, I am the inaugural Chief Clinical Informatics Officer at CAMH, representing our nurses and all of our non-physician health disciplines, like social work. And I have a couple of other hats as well. So one is that I'm the head scientist of the digital mental health lab, and I'm also the scientific director of our Digital Innovation Hub, which is about really accelerating our work in this digital sphere and research practice, education and beyond.

So that's about me, but I'll move on to talking about CAMH. So CAMH is C, A, M, H, the Centre for Addiction and Mental Health, and it's Canada's largest mental health and addictions teaching hospital. We think, and I think there's lots to suggest that we're true in saying this, that we're a world leading Research and Education Center on mental health, and we're located right in the heart of downtown Toronto, but we serve people across our province, Ontario and across the country as well. In terms of a few numbers that I'll share with you, we've had just over 16,000 emergency department visits in the last year, over 40,000 patients that were treated, over 80,000 virtual care appointments. And I'll provide a few more numbers here as well, almost 8000 RTMS visits, 60 million in a new research funds more than 1000 articles published. I think you get the point that there's a lot going on at CAMH, and it's a great place to be.

 

Danny 03:48 – 04:50

You know, I have been on your campus a number of times. I always appreciate that your campus is right in the heart of Toronto, in a bustling area, and I think there's, there's no greater way to reduce stigma than, you know, placing such a well-respected mental health and addiction treatment organization right in the heart of the city. Whereas if you go to many other communities, you'll kind of see the mental health hospitals and treatment providers kind of on the outskirts of town. Really appreciate CAMH’s role right there in the heart of Toronto. And I think this goes into something Gillian that you speak about passionately, which is the idea that mental health treatment is social justice. For our audience, tell us what you mean by that. Why is it an important lens - social justice, which you view your work?

 

Gillian 4:51 – 07:43

I think it's quite an important point that you bring up, Danny, and it's something we're really proud of talking about, that mental health work is social justice work. Part of doing social justice work is to be informed in this space. And part of being informed is understanding that mental illness disproportionately affects marginalized communities who are also often facing barriers to things like accessing care, and this could be due to racism, poverty, stigma, geography, and I could continue so on and so forth. At CAMH, we see mental health is deeply rooted in social justice, because access to care, dignity and treatment and prevention are not actively distributed. CAMH advocates for policies and systems change that ensure mental health care is not a privilege but a right. And so that's really our social justice lens, framing and shaping the last few statements that I made.

We have done some work more recently in the last couple of years on dismantling anti-black racism, which has become a more formalized organizational commitment. I'll just read a section from one of our documents around dismantling anti-black racism. And excuse me for it sounds like I'm reading here because I'm reading from a document, but systemic anti-black racism, is a barrier to high quality health care for black patients at CAMH and across the health care system, the data lay bare with those in black communities have signaled for decades. Discrimination and oppression based on race delays care and harms individuals on their way to recovery. Racism also has a negative impact on the quality of work life for black staff, beyond the damaging emotional and psychological consequences, it limits their career trajectory, and it goes on from there. I bring this out as one of the many initiatives that the organization is committed to. And as a result of this commitment, this public commitment, you can read what I just read on our website, camh.ca, that there's a number of activities that the organization is doing everywhere, from doing offering more culturally appropriate therapies to education for staff, staff support groups, creations of processes that support equity, lots of advocacy work with the government. A lot of this work is ongoing, but this gives you sort of a more grounded, more concrete example of some of the ways in which we look at social justice as being so related to mental health.

 

Danny 7:44 – 09:31

My goodness, you know the social worker in me is just grinning from ear to ear, as you describe, you know, the foundation in which CAMH is caring for folks. You know, I'm still a licensed clinician in Missouri and Alaska. You know, particularly, I think about a state like Alaska, with a disproportional number of folks who are Alaska Native. And we see, you know, in those communities, so much generational trauma, and the impact you know, and the impact that oppression you know has on sort of repeating traumatic occurrences across the generations and so, so very important, I think, an important perspective to look at the the experience of mental health and the treatment of mental health through a social justice lens. Gillian, I just appreciate that, that that is a focus of CAMH, and I'm sure the indigenous populations your organization works with, you see a similar, you know, a similar experience than the those in the in Alaska here. Now, as we pivot here, thinking about, you know, you're, I think the work you're describing, from a social justice perspective, is innovative. It seems like CAMH is always at the cutting edge of innovation. We're a technology company, and so, you know, from a technology innovation perspective, what are you seeing? What's CAMH doing?

 

Gillian 9:32 – 15:53

Great question. Danny, and because of my various roles at the organization, I get excited about this kind of a question, and it also describes the work that I'm doing every day, with my colleagues, with our patients, their family members and others across the organization. So yes, we're always interested in how we can use technology and to innovate with technology, but we do that so we can achieve various things and the things that we want to achieve are being able to improve access to care so we can see more patients, because probably unlike, or not unlike various organizations in the rest of Canada and in the US, we have long waiting lists for care. The second is to be able to improve the quality of care. And not to say that care isn't good already, but more that as we learn and develop evidence and get feedback from our clinicians, from our patients, we can then integrate that into care. So that's the second piece. The third is to improve the patient experience, and the fourth is to really personalize care. When we think about how we innovate with technology, we're really looking to see if we can do those four things. And yes, there's other, you know, other reasons you invest in technologies for various efficiencies and cost savings. But I'm going to talk about more work on the earlier four points that I described.

So maybe I'll provide a couple of concrete examples. The first one is thinking about the opportunity that we have by embedding wearables into care processes. These are things like Oura rings or Fitbit that you know, it doesn't matter which company it is. There's lots of wearables out there, but embedding them into care processes so we can look at sleep and activity which are often impacted when people have symptoms of depression or anxiety. We hope at CAMH to use this information to better understand someone's individual patterns, which could really help us tailor their treatments, as you can imagine, but also be able to identify early when a treatment may be starting to take some effect, or an early warning sign, or an indicator of someone potentially falling ill or relapsing. Lots of potential in that space, and we're getting going primarily in the research domain, in the wearable space. So that's sort of one concrete example.

Another concrete example is RTMS. So CAMH has been a leader in this space and doing brain stimulation research for a number of years. RTMS, in case listeners aren't familiar with it. It's a non-invasive treatment. It uses magnetic fields to stimulate very specific regions of the brain, and it's been shown to be particularly effective for people with treatment resistant depression. These are individuals who have not responded well to medication or therapy alone. To date, we've had about 8000 individuals last year who have received RTMS. We're thinking about it from advancing the science, treating individuals, of course, and doing lots of advocacy work.

The third example I'll provide is around the app space. There's lots if you were to type in depression or anxiety into any app library, you're going to see lots and lots of apps, most of which don't have a scientific backing to them, some of which may actually be a waste of time to engage in. It's also really hard to make sense of that app landscape. So, we've been working to develop and integrate into clinical care processes, apps that have that evidence base behind them, and have some sort of a portal or interface with clinicians so that the data can be used for care purposes. We've got one called my change plan for smoking cessation of behavioral modifications. We've got one called App for independence, which is a platform for supporting people with complex behavioral and mental health conditions, and it's currently used for recovery processes with individuals with psychosis and schizophrenia and now opioid use disorders. And then we also have another app called Hope by CAMH, which is a safety planning intervention for people at risk for suicide. So, there's, you know, that doesn't cover all the apps, but gives you a sort of a flavor of the various apps that we've been working on, so that there's the credibility the science and the engagement and feedback loop for those particular areas.

And then the finally, the last one I want to talk about is our electronic health record. We use the Oracle Health platform, and we're really thinking about how we can optimize our use of it for the best experience for clinicians and patients alike, including this concept of open notes through our patient portal, so where patients can see their notes and so well, if you're in the US and thinking, well, this is the norm for us, it's not quite the norm for folks in other countries. It's optional in Canada to share mental health notes, and so we're showing some real leadership by identifying how best we can do that and opening up our notes. So I'll just close on this topic, Danny, by just saying that importantly, we're taking a human centered approach when we're doing this work, whether it be in apps, wearables, with our EHR that we're co-designing with patients and clinicians to ensure that they're usable and they meet the needs that are the most pressing needs, but also that we deliver and implement technology that allows us to provide compassionate care. Because I think when we think about technology, it's often this sort of antithetical approach to compassion. And we are showing that to be able to deliver compassionate care in this day and age, we have to be innovative in our use of technology.

 

Danny 15:54 – 18:07

Wow. What a, what just, what a robust list of innovation. You know, that CAMH, is sponsoring. I'm not, not at all surprised Gillian, knowing your history. You know, Gillian, maybe a part two to this conversation. A separate podcast can be sort of on the intersection of social justice and technology. You know we regularly describe some just phenomenal innovation, consumer facing innovation and yet, we know that there's consumers of care that don't always get to take advantage of the latest and greatest innovation. The wearables or access to a device to allow, you know, portal or telehealth. You know, lack of hardware, lack of bandwidth, lack of sort of knowledge or trust in the available tools. So, you know, maybe we can. We'll bookmark that, I think for another day, but in the area of innovation, CAMH was part of our clinical AI work group for behavioral health. This was a year-long process. You know, Oracle has been an AI space for many, many, many years. You know, I'm sitting in a Marriott right now where, you know, I used Oracle tools to check in and to engage with the Marriott staff. Oracle knows a thing or two about AI, and has taken what they know about AI and applied it to healthcare. And we, Oracle Health, and CAMH and others have taken that and morphed it for behavioral health. So, our clinical AI agent today is available in the US in behavioral health, used across a number of behavioral health providers. I think to date, we've had nearly 20,000 medication management notes that were documented using Oracle Health's Clinical AI Agent. So, what's CAMH thinking about from an AI perspective?

 

Gillian 18:08 – 22:38

Oh, we're thinking about lots from an AI perspective. And I will just note that while you're sitting at a Marriott, I'm sitting at the hospital right now, and on the overhead speaker is a code being called. Apologies if you can hear that. We are really quite excited about the potential for AI and what it could bring for things like research, education, of course, clinical care, and how we operate and potentially achieve some efficiencies. I think there's a whole bunch of areas where we see the potential for AI. We're fairly early in our journey, but we're setting up all the right infrastructure so that we can accelerate more quickly. The first is that we recently launched, just this month, a BMO chair in artificial intelligence and mental health. So that's a research chair role specifically for AI in mental health, and I believe it's the first and only in Canada at this time. So Dr. Tristan Glittard Is the inaugural chair. He's an AI computer scientist, researcher and engineer, highly collaborative with clinicians. I think we have high expectations for what this role will achieve. We're also hiring for an AI scientist. From a research perspective, I think we expect big things, and I'll have more to report back on Danny in the not too distant future around that one.

In terms of education, we currently have a digital mental health and AI Certificate Program, which is free and currently available on our website. So folks here who are listening are welcome to go to camh.ca and who and can navigate to finding the digital mental health and AI certificate program, and that's really thinking about, mostly for clinicians who are working in this space where there's more AI tools available for them to develop their competencies and thinking about how to use them within their clinical practice. We're getting, sort of our baseline of folks ready so that we're able to really accelerate in this space.

And then I'll just mention one thing lastly, and while we don't have anything concrete yet to share the potential of AI scribes and ambient scribes, and using this sort of technology to free up our documentation time for essentially all clinician types is of big interest. Not just the documentation, but also other tools like being able to do note summarization or querying the electronic health record or the patient record. So I think all of these sorts of things are of interest for us, and our clinicians would jump on at scale. These sorts of things can have a big impact. And I'll give you an example. Not too long ago, we did a fairly small change in our EHR, and it result, and that was about nurses reducing their documentation time. We took out some particular areas of a power form. It resulted in a couple of seconds per power form that nurses were not documenting anymore. But when we calculated the total time savings over the course of the year for nurses, it was the equivalent of a full-time nurse by just doing that small change. And so if we think about that's just a really small example that we saved a full 1.0 full time equivalent of nursing time. If we did that at scale by using ambient scribes, by doing things like note summarization and querying, we could really take that to the next level and save large amounts of time, which we hope, could really support clinicians in being even more engaged less burnout. You know, the list goes on. So of course, in doing any of this work in AI, we need to be mindful of risk and bias, ethics. So there's a lot to be mindful of there, ensuring we keep mental health care human and so we're really making sure we're getting this right. We're starting our journey to ensure that we have all these various safeguards in place. But I will say it's a really exciting place to be. There's some very cool tools coming out, and I can't wait to get my hands on them.

 

Danny 22:39 – 23:58

Yeah, Gillian, we are so excited. You know our psychiatrist, psychiatric nurse practitioners, nurses, social workers, case managers, therapists, all benefiting today from use of Oracle Health Clinical AI agent. So, thank you for sharing those insights. Now. Before we close, we want to remind our listeners that if you or someone you know is struggling, help is available. In the US you can call or text, 988, 24/7 365.

988, is the suicide and crisis lifeline in Canada also, 988, 24/7 365, and just interestingly enough, 988, in Canada is provided and managed by CAMH to ensure that no one has to face a crisis alone. Trained responders are there for support. Dr. Gillian Strudwick, thank you for sharing your insights and for the work you and CAMH are doing every day to make mental health care better, smarter and more just. And thank you to our listeners for tuning in. Take care of yourselves and each other.

 

Outro 23:48 – 24:20

That's all for this episode of perspectives on health and tech podcast, be sure to subscribe to catch all our future episodes. For more information from industry experts, visit oracle.com forward slash health and oracle.com forward slash life hyphen sciences, or follow Oracle Health and Oracle Life Sciences on social media. Thank you for listening and join us again for the next insightful episode of perspectives on health and tech.

 

 

 

In recent years, there’s been a significant rise of AI technology and hyper-scalers entering the healthcare market. Listen in as two experts from Oracle Health discuss improving healthcare delivery through the integration of these technologies, particularly focusing on the role of AI and comprehensive data platforms on value-based care. Learn about improving care coordination and delivery, the shift to scalable platforms, and incorporating AI and cloud technology to continuously evolve with the needs of healthcare systems.

Featuring:

Bharat Sutariya, MD, Senior Vice President and Chief Health Officer, Oracle Health

Scott Wiesner, Go-to-Market Strategy and Operations, Oracle Health

Listen as they discuss:

- Dr. Sutariya’s perspective on the current healthcare landscape (2:50)

- AI in service of improving value-based care (4:15)

o Growth of hyper-scalers in the healthcare industry and what is lacking with this technology specific to healthcare

• • The need for a comprehensive data platform that aggregates across multiple sources with terminology mapped to data and ontology applied for meaningful data

- Going forward with industry-based data platforms (7:25)

o Applying AI and genAI

o Applications with pre-formatted workflows running on a comprehensive platform

- Facing challenges in value-based care and technology choices (14:16)

o The option of platform as a service (PaaS) helping to meet the needs for value-based care contracts

- The Oracle strategy with cloud and genAI-based advancements (15:54)

o EHR agnostic capabilities

Notable quotes:

“We now have a unique opportunity, particularly leveraging the might of Oracle, to layer advanced AI, including generative AI, on top of our existing healthcare technology – taking us far beyond where we were before.” - Bharat Sutariya, MD, Senior Vice President and Chief Health Officer, Oracle Health

“At the end of the day, with value-based care, it’s really about the insights you get from the data – how do we make better use of that data in service of improving healthcare outcomes?” - Scott Wiesner, Go-to-Market Strategy and Operations, Oracle Health

CTA:

Want to enhance a connected healthcare ecosystem and accelerate value-based care efforts while improving clinician decision-making and the patient experience? See how Oracle Health can help with our suite of population health management solutions here: https://www.oracle.com/health/population-health/ 

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Episode Transcript:

Introduction  0:00 

Music.

 

Introduction 0:13 – 0:28

Welcome to perspectives on health and tech podcast brought to you by Oracle Health. In this series, we have conversations on creating a seamless and connected healthcare world where everyone thrives. Let's get started.

 

Scott 0:29 – 0:58

You’re listening to perspectives on health and tech. I'm Scott Wiesner, Senior Director go to market strategy in Oracle Health. With me today is Doctor Bharat Sutariya, Senior Vice President and Chief Health Officer in Oracle Health. Dr. Sutariya has over 20 years-experience in care delivery transformation, value-based care, and healthcare technology. He's also board certified in emergency medicine and has practiced medicine for over 25 years. Welcome Bharat.

 

Bharat 0:59 – 1:00

Scott, it's great to be with you.

 

Scott 1:00 – 1:08

Great to have you. Very fortunate to have you here at Oracle as well. Let's get into it. Why don't you tell us a little bit about what's driving you these days?

 

Bharat 1:08 – 2:30

Scott, in many ways, it's the same thing that has driven me for the last 25 years, and that is to significantly improving the healthcare ecosystem of providers, payers, and the life sciences, and to achieve the best outcome and experience for the patient. I've spent the last couple of decades developing and deploying healthcare technology products and solution and I've been fortunate to partner with leading health systems that think forward and solve complex problems that others mimic in healthcare then. I'm excited that I have this potential to make a significant progress, because I believe that the technology is more aligned to the problem now, and our ability to solve the problem now is better than ever before. So that's what excites me. Last thing I would say is it's great to be back now at Oracle Health, because Oracle is a full stack company having the most modern and efficient database, cloud infrastructure application development and proven, you know, technology over decades, and it's really taking that advantage of that capability and applying to health care, it likely excites me the most.

 

Scott 2:31 – 2:52

Well, it's great when passion and experience come together. Let's sort of take the next step here. This This podcast is about perspectives, and particularly your perspective, and you've got a very extensive and a lot of experience as a practitioner, educator, implementer, and, of course, executive leader quite some time. Let's talk a little bit about, you know, what you're seeing in healthcare at this moment.

 

Bharat 2:53 – 3:36

Interesting question. You know, I feel like we are at a unique juncture in healthcare where multiple forces are coming together. The cost of healthcare is rising. The outcomes are not necessarily keeping up. All of us are paying more out of our pocket, and overall, you know, that's not a sustainable system. But what's exciting is that we now that technology, you know, particularly with novel technology coming that has such an amazing promise to solve complex healthcare that it, you know, it, it gives me so much passion to look forward at solving these problems that we haven't been able to solve in the last 27 years.

 

Scott 3:37 – 4:17

So, you know, technology is both a promise and a solution. And what we're hearing from customers today really true of any industry. How do I reduce that cost? But then take those cost savings and power innovation. That's kind of the two levers there that you that you want to pull to drive efficiency and better outcomes. And one of these things we can't talk about in this day and age, whether, you know, without spelling it out, of course, is artificial intelligence. And really, how do we look at artificial intelligence and generative AI in service of, you know, improving value-based care? Can you elaborate a little bit on those two areas?

 

Bharat 4:18 – 6:50

As you know, my healthcare is very broad, and the movement toward value-based care, of course, many models, ranging from shared savings to full risk arrangement, both in commercial and government space, continues to grow, so I think it's an important topic. Now. I've spent a decade on value-based care strategy, technology development and partnering with health systems to really enable success in value-based care model. And there, you know, I've learned quite a bit, right? You know, I see going forward, the hyper-scalers have already made a significant progress with the penetration into healthcare, but I'm not sure that that hyper-scaler presence in healthcare has particularly been uplifting for value-based care, because in order to achieve value-based care in a programmatically and sustainable way, you have to solve some core challenges. And in the hyper-scalers, they'll provide robust technology platform, they've not necessarily solved these challenges. And the challenges that I'm talking about is, first and foremost, you have to have a very comprehensive data platform that aggregates data across multiple data sources, and that data sources need to have a high degree of terminology mapped to it, and then ontology needs to be applied to make meaning out of it, because what happens in healthcare, in particularly value-based care, is that an average value based care provider is likely providing 50 to 60% of care in their own network, meaning they have the data, but the rest of it is provided outside of their network, into the community for which they don't have clinical data, and they can only get the insight by using the claims data. So, what's happening is that the forward looking, advanced value-based care organizations have a desire to aggregate this data from multiple EHRs, where patients get their care, multiple payers, where they have taken payer contracts. They want to get data across VBM, social determinants of health, and basically anywhere patient is touching healthcare institution. They want to understand that data, because it is that aggregated data that can give them the full insight so that they can then provide a comprehensive care.

 

Scott 6:51 – 7:27

Yeah, it's a great point. You know, whether you're a hyper-scaler or otherwise, you know, everybody can provide a data platform where you're aggregating data. You know, some version of that. What we're describing here actually is, how do we make that better use of that data in service of value-based care, and all the contracts and regulations and things that you pointed out once before is, you know, always changing. And you can't just solve that like, you know, everybody can do that, but it's really the next thing. So maybe you can elaborate on that a little bit more, and where we're going with industry-based data platforms.

 

Bharat 7:28 – 9:27

I see many in the industry are starting such a platform today. While we've had a decade head start, we've had Healthe Intent for more than a decade now that has been recognized as a highly scalable world class data aggregation platform that reconciles large swath of data, you know, maps it and creates a medical grade longitudinal record. And we've been able to use this platform to help our customers achieve initial success in value-based care model. On top of that platform, you apply intelligence, you create gaps in care insight, you also empower the risk adjustment capability as well as care coordination capability and all of that together then operate, you know, provides operational capability for the value-based care organizations. So that's kind of the current state of where we are, right. And while we have a highly organized platform and software approach, you know, I feel like many in the industry are still catching up, you know, to where we are. We now have a unique opportunity, particularly leveraging the mind of Oracle to layer, you know, advanced AI, including genAI, on top of it. So, imagine, you know where we were, which was already fairly advanced, and now we have the ability to layer more advanced capability on top of it, and that is the go forward future. And at least you know that Healthe Intent that people know today is now the Health Data Intelligence that has all this capability that I just talked about.

 

Scott 9:28 – 9:52

So let me just take a step back just for a minute. Here, seems we kind of talked about the table stakes of a data platform. And of course, in order to enable generative AI in particular, as you mentioned, seems to me you kind of got to get your house in order. And if I make a little bit of pun out of out of this, not your just your house, your data warehouse, in order, in order to enable artificial intelligence and generative AI, is that that's sort of the trend that we're seeing here.

 

Bharat 9:53 – 10:55

Yeah, we were able to get a head start into this generative AI and overall intelligence powering the value based-care platform, because we already have a strong foundation. If you don't have the right data foundation, particularly across the broad network of aggregated data, then the models you deploy on top is not going to work. So that's point number one. Two, you also need this platform that's evolving with the continuous technology as well as continuous intelligence. And that's, you know, where we’re going as well is to have an agile platform with the agile software capabilities on top of it, and continuous layering of AI, with the end result being able to power every component of value-based care management, from a clinical intelligence, from a care coordination, and from an analytic perspective.

 

Scott 10:56 – 11:36

So, on one hand, you talked about hyper-scalers, kind of on the one end, and marshaling the data for these insights. There's also the other proposition, where, hey, look, you know, there's, there's vendors out there that provide these insights, sort of out of the box, but they're not a they're not a hyper-scaler, they're not a data platform. So can you talk a little bit about that end, because at the end of the day, with value-based care for my what I'm gathering here is, it's really about the insights that you get out of the data. So, we could talk about kind of the dashboard approach. You talked about the data platform. Talk a little bit about kind of the SaaS version of the software as a service, kind of dashboard, end of things.

 

Bharat 11:36 – 14:15

I think, you know, strong platform that aggregates data is obviously, you know, needed in a strong set of applications that run on top, that have pre-formatted workflow, is also needed. But as we go forward here, we have to advance more than that, and that's where really the use of Gen AI capabilities come into place. That we no longer have to build an application or a analytic query or dashboard for every single things that we want to know from an insight to make a decision about value-based care. We're now able to use modern technology, particularly the Oracle analytic cloud, infused with the artificial intelligence, so that we're able to treat analytic almost like a conversational search. We're able to ask the analytic engine, for example, show me all of the patients that have hemoglobin A1C greater than nine, that have not seen physician in the last six months, and that don't have an appointment coming in the next six months, and the system is able to show you to list the patients with all the pertinent data so that a care coordinator or a physician's office can act and get them on the schedule. In the past or even in current systems, some would say, you would have to build a specific dashboard workflow to achieve that insight. But going forward, we're able to use the AI-driven analytics to achieve such insight. By the way, all of it needs to be based on world class security and data privacy. I don't think we can say enough of that. That is such an important concept in this day and age that, we restore health data and deal with health data, the security needs to be a first-class priority. Now, the other interesting part Scott is the VBC contracts are continuously changing. The network continues to change, the regulatory environments continue to change, and you also need a platform that's agile, that's constantly evolving at the platform level, application level, and the AI that's integrated into it needs to also be highly adaptive to serve the ever-changing business needs.

 

Scott 14:16 – 15:03

So of course, if you're speaking to your friends who are heads of population health, chief medical information officers. Sounds like they're kind of facing some of these challenges. Look, I've got some regulatory requirements, you know, I want to develop really precision of care for value-based care. Wanted to also take advantage of some of these new innovations in generative AI, all, it sounds great. What are these folks facing today? There's, there's a lot of choices in the industry as well. You know, as having been in the industry for over 25 years, lots of choices, so I'm kind of seeing this, as you said, the other side and made me think of, you know, the two sides of the same coin. Hey, look, we want to use our money wisely one side, and you've got to be able to have a fast, scalable, secure platform, and you also have the interface to be able to utilize that data most effectively. Describe a little bit of that for me.

 

Bharat 15:03 – 15:53

Scott, I think it's important the choice of technology to our value-based care needs to be highly strategic in nature. In the past, you know, there was difficulty in choosing big strategic platform. How long will it take for me to stand it up and mature it right? But now, with the platform as a service, the choices are a little bit easier, and how fast you can get value out of it is also easier. So, I think in today's day and age, you can achieve both, and that is, how do I get technology that can help me meet my needs for this year's contract, but more importantly, how does the investment evolve with my needs over many years, and that is the balanced choice that people can make today.

 

Scott 15:54 – 16:27

Yeah, and that makes a lot of sense, because, you know, people are moving careers and jobs, and we as a provider, a technology provider, need to show a value today and tomorrow and of course, beyond. Makes a lot of sense, and to be able to think strategically, obviously, also makes sense as well. Lot of technologies over the years to meet some of these requirements. And so look, we're both Oracle folks here, and you know, we'd be remiss if we didn't talk a little bit about to our listeners here about the Oracle strategy, covering both cloud and generative AI based advancements. Can we talk a little bit about that?

 

Bharat 16:27 – 18:43

Yes, Scott, let's, let's make sure we earn our pay. I'm super excited about the path that we're on. And quite frankly, I don't think that path was possible prior to acquisition of Cerner by Oracle. As I mentioned earlier, Cerner had previously developed Healthe Intent platform that's been in place for more than a decade, and having personally been involved, we leveraged the best possible technology components that were available at the time several years ago, and there was even an attempt to make sure that we keep the platform updated, but we now have an amazing new opportunity, and that is to leverage the total might of Oracle. You know, Oracle being a full stack company, it has the most modern database. It has the modern cloud infrastructure. It has the modern cloud analytics capability. It has the generative AI capability. So when we put all that asset together in one full stack, we're able to do things that we could not do in past. And that is what our teams have developed now into health data intelligence on top of this, health data intelligence as a platform, we layer a new set of application called Clinical intelligence, care coordination analytics, and then many purpose-specific assets such as HCC and many different risk models associated with it. We do all of this in a completely EHR agnostic manner, in fact, system agnostic manner, so not every customer has to have our own electronic health record to benefit from it. It doesn't matter to us, which EHR brand you use, what hyper-scaler cloud you may already be aligned to, from a data storage and computing perspective, we're able to coexist because this is a purpose-specific healthcare intelligence platform, and then when it's used for value-based care, we actually have a purpose specific value-based care applications in workflows that go on top of it.

 

Scott 18:43 – 20:09

Yeah, that’s interesting. So, and I wanted to kind of go back something that was, was interesting. And I think our, our listeners, customers, can identify with your journey, you know, as a almost a developer as well, you're saying, you know, filling the needs of the requirements of your customers where, you know, look, not all of our customers are, you know, some of the hyper-scalers out there, they've got, you know, they're not IT companies, you know, they're really interested in the outcomes, not developing and supporting a data platform, you know, a non-industry data platform. Even though, as you pointed out, the hyper-scalers have made some inroads into that. And t's about, again, outcomes. How do I make value-based care more efficient? Allow for better insights, kind of time to value of data and that precision healthcare that we talked about, again, about the outcomes at the end of the day. So, if we as Oracle, can provide that platform, that we manage, that then drives and allows you, the customer, to take advantage of all those insights. Really want to be here for you for that so when you're ready for that next step of generative AI, not having to manage the platform itself, but also getting the insights through the applications that you mentioned. It's already there for you, and can basically start with that the very next day. Any final thoughts, Bharat?

 

Bharat 20:10 – 20:34

It's my pleasure, and I'm actually quite excited to leverage all of the assets we now have from previous Cerner and now Oracle, and it's exciting to be part of this journey, and looking forward to working with our customers to get it in their hands and help them achieve their value-based care outcomes.

 

Scott 20:35 – 20:45

Fantastic. Thank you very much, and thank you for listening. Be sure to subscribe to the perspectives on health and tech podcast. Thank you very much.

 

Outro 20:45 – 21:20

That’s all for this episode of Perspectives on Health and Tech podcast. Be sure to subscribe to catch all our future episodes. For more information from industry experts, visit oracle.com forward slash health and oracle.com forward slash life hyphen sciences, or follow Oracle Health and Oracle Life Sciences on social media, thank you for listening and join us again for the next insightful episode of Perspectives on Health and Tech.

 

 

Discover the Value of AI in Healthcare

Are you interested in using AI tools to drive operational efficiencies within your organization, but not sure where to start? Listen in as two industry experts from HIMSS and Oracle discuss how AI is helping to transform healthcare operations and how to consider implementing AI technology in a healthcare organization. Hear about how AI is being used in healthcare today, risk factors to consider before implementing AI tools, and how AI can be used to boost clinician satisfaction while helping to reduce operational waste.

Featuring:

Mary Ann Borer, Senior Copywriter, Strategic Marketing Services, HIMSS

Matt Patterson, Executive Director of Oracle Health AI, Oracle

Listen as they discuss:

-        How AI is being used in healthcare IT today and the impact it is having on the industry (1:00)

-        Key factors that are important to consider before implementing AI technology in healthcare systems (6:45)

-        Clinical and healthcare business workflows that may be best suited today for AI applications (8:20)

o   Automation vs augmentation

-        Key risk factors to consider when adopting AI in clinical practices (12:20)

-        Which aspects of AI may add the most value to help improve the efficiency of current processes (15:22)

-        What’s to come for healthcare AI in the future (21:35)

Notable quotes:

“My number one area of opportunity in healthcare, that’s best suited right now, today, for artificial intelligence is addressing physician and clinician burnout.” – Matt Patterson (9:47)

CTA:

Learn how Oracle is working to reduce the documentation burden on physicians and elevate the patient experience with the Oracle Health Clinical AI Agent.

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Episode Transcript:

00:00:00:00 - 00:00:38:08

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 this episode, you'll hear a conversation recorded by HIMSSCast where the host and guest speaker delve into unlocking the value of AI within healthcare. Your host for this session is Mary Ann Borer and the guest speaker is Matt Patterson.

 

00:00:38:10 - 00:01:05:11

Mary Ann

Hi, I’m Mary Ann Borer with HIMSS. Today I'm joined by Matt Patterson, executive Director of Oracle Health AI at Oracle, and we'll be talking about unlocking the value of AI within health care. Matt, thanks for joining us today.

Matt

Thanks for having me, Mariana. I'm excited to be here.

Mary Ann

Wonderful, Matt. Can you start off by telling us a little bit about how artificial intelligence is being used in healthcare IT today, and what impact does it have on the industry?

 

00:01:05:13 - 00:01:31:21

Matt

Yeah, absolutely. And I'll start just kind of a brief introduction of my, my experience here leading into, what's been one of the most exciting chapters in my career. But I've spent about 15 years in health care, serving in a variety of different health care entities across the globe to extract value from technology investments. So have had the opportunity to really work with some large scale players across the globe.

 

00:01:31:23 - 00:01:56:14

Matt

And that's enabled me to learn some from some of the most innovative, forward thinking leaders across the industry on a variety of use cases. So I really started, in the heat of the adoption of core EMR technology during the meaningful use era. And throughout that journey, you know, 15 years ago till today, standing up care management programs to support value based care, you know, revenue cycle optimization initiatives.

 

00:01:56:14 - 00:02:22:03

Matt

Most recently, I led a venture around, a lab is strategy to advance diagnostic capabilities, which is another topic, but one that I believe, you know, diagnostics has so much room for, for growth in the future. But that's often back of mind for health care organizations today. But again, as I noted, this AI initiative is really the most fun that I've had in my career.

 

00:02:22:05 - 00:02:54:01

Matt

Of really just the value that it's bringing to healthcare professionals. To start off, just, you know, backing up a little bit around AI and healthcare, it's obviously the buzz of the last, you know, 12 plus months. But AI has been in health care for nearly half a century, and I refer to it as classic AI. It's used to carry out a specific task that a human typically performs, recognizing patterns and data to predict and drive what might happen next, or summarize what's already happened.

 

00:02:54:03 - 00:03:28:13

Matt

Or making suggestions. What's really happened in the last 12 plus months is within healthcare is leveraging generative AI. That's the newest development in healthcare that leverages massive amounts of data and computing power to look at things in a much broader context and generate something completely new. So GenAI generate documents that can summarize existing information. It can translate a document and extract information and classify text based on a specific request.

 

00:03:28:15 - 00:04:07:01

Matt

ChatGPT is obviously if anybody has actually tested that, it's a really good example of ask a question and it will give you a very succinct, summarized answer that's structured better than a lot of what humans can do. And so that's really where we're seeing this substantial shift in the healthcare industry is this shift from classic AI, which is if this happens, then I can drive this result to generative AI that truly can create something completely new around automation of administrative tasks, looking at precision medicine, etc..

 

00:04:07:03 - 00:04:29:06

Matt

And as you think about just the impact on what generative AI can really bring to healthcare AI, I go back to what Bill gates, an article he wrote in 2023 after he really he had a meeting with OpenAI and it started to click for him around what AI is really going to mean foundationally for a variety of industries.

 

00:04:29:06 - 00:04:55:15

Matt

But, you know, in his article, he was kind of focusing on health care. And, and he said this “AI will become as fundamental as the creation of the personal computer. It's going to change the way people operate to face some of healthcare's most significant challenges and rising costs, lack of equitable access and aging populations, doctor, nurse burnouts and global pandemics.”

 

00:04:55:17 - 00:05:37:22

Matt

We're already seeing a lot of those impacts at different levels, leveraging GenAI so, you know, rising he mentioned rising costs. Today we're, we're driving operational efficiencies across health care around more efficient scheduling, claims processing, supply chain management and eliminating waste of supplies through real time forecasting, timely interventions of care that can eliminate readmissions and higher acuity costs.

 

00:05:37:22 - 00:06:06:16

Matt

So we're impacting the cost curve already through AI, lack of equitable access to care. Social determinants of health is a big thing that we're embedding into a EMR today to provide an Uber access so somebody doesn't miss their appointment. And doctor nurse burnout. So I'm going to get into more of that today because that's where I'm spending a lot of my time within Oracle is addressing administrative tasks through leveraging AI.

 

00:06:06:18 - 00:06:32:07

Matt

In short, the integration of AI and healthcare. It truly is transforming the industry by improving accuracy and diagnostics and treatment, reducing costs, and ultimately leading to better patient outcomes. But we'll get into some of this today. It also raises important considerations regarding data privacy, like the ethical use of AI, how to put controls around it, and the need for regulatory oversight.

 

00:06:32:07 - 00:06:48:00

Matt

So overall, it's playing a crucial role around the evolution of health care. It's making it smarter, more patient, more efficient and more patient centered. But important to put controls in policy as organizations look to bring AI into your organizations,

00:06:48:03- 00:06:55:12

Mary Ann

What are some key factors that you consider important before implementing AI technology in health care systems?

00:06:55:14 - 00:07:28:12

Matt

It's one that I receive often. Where do we start? So the possibilities when you really dig into the technology of cloud hyper-scalers, the capabilities are endless, which is exciting. Yet it's also overwhelming when you really kind of dig in to what the possibilities are. So where to start is hard. And so a lot of clients and folks that I'm working with week in, week out, I give them this simple advice : start small and start now.

 

00:07:28:14 - 00:07:59:09

Matt

You can go address low risk use cases. Now to learn the technology, understand how to wrap your arms around it, and put controls and protocol around it before you get to those larger scale, higher risk use cases such as do I drive a diagnosis directly to a physician into their physician workflow, you're going to want to put a higher level of protocol controls and risk management around that type of larger AI.

 

00:07:59:11 - 00:08:15:00

Matt

We'll call it recommendation. In comparison to something like, how do I go create a draft note for a physician to have to review? So in short, my recommendation is always start small, but get going now.

00:08:15:02 – 00:08:25:09

Mary Ann

 Now that's an excellent point. And let me add to that a little bit and ask you which clinical and health care business operations do you feel are best suited for AI today?

 

00:08:25:11 - 00:08:52:24

Matt

So as I mentioned on the front end, I've been fortunate, to have a variety of experiences across, the healthcare entities I've worked with throughout my career. And, I'll tell you, from my experience, it's all of the functions of the healthcare system that need automation and really need to have the opportunity to eliminate manual process and waste, supply chain.

 

00:08:53:00 - 00:09:21:00

Matt

You know, I mentioned AI, more effective predictive analytics to eliminate waste, huge opportunity across our healthcare system, of, you know, things that aren't necessarily needed and are wasted on a daily basis, that if we had more effective ways to forecast what's needed and when we could eliminate cost, eliminate that waste within our supply chain management system. Revenue cycle, there is more manual process in rev cycle.

 

00:09:21:02 - 00:09:47:11

Matt

And there are more tools coming out to augment that. Those manual processes, leveraging AI. So the automation of coding and prior authorizations claims processing, denials, management, a variety of aspects of how we can automate manual process today, predictive analytics to reduce readmissions, health equity programs that I mentioned on the front end. There truly are countless opportunities across the functions of healthcare.

 

00:09:47:13 - 00:10:20:00

Matt

But my number one area of opportunity in healthcare that's best suited right now, today for artificial intelligence, is addressing physician and clinician burnout. So before I get too far into the why there, I just summarize the where to start through the evaluation of two different concepts. One is automation. The second is augmentation. So think of automation as the automation of a process.

 

00:10:20:02 - 00:10:56:18

Matt

Creating a note automatically driving a code within for an ICD ten coding. It's addressing an administrative task versus augmentation. Is the AI actually providing a recommendation directly to the end user? I personally believe that as you think about those two concepts, the nature of what health care serves myself, my mom, my dad, my kids, it's so personal that we really do need to be careful with AI.

 

00:10:56:20 - 00:11:30:24

Matt

And so starting with automation of process and the administrative burden, there is so much opportunity there. My recommendation is start with automate automation. As you as we continue to see the AI improve, which it will exponentially in the coming years, I think that's when we start to look at the augmentation of care. And there are a variety of organizations out there that are continuing to look at this augmentation concept, meaning I want to drive a recommendation of a diagnosis or a treatment plan directly into the clinician workflow.

 

00:11:31:01 - 00:12:02:20

Matt

But again, my $0.02 starting small. Start with automation of administrative process. And as AI improves, think about da Vinci three to chat GPT four. There has been so much improvement around AI hallucinations, and those hallucinations are real in artificial intelligence. The iterations of AI will just continue to improve. And so as the AI improves, I think that's where there will be our opportunity to get to the next level of that true augmentation of healthcare.

 

00:12:02:22 - 00:12:05:01

Matt

That will really take AI to the next level.

00:12:05:03 – 00:12:23:01

Mary Ann

That's such a great point, especially when you think about how some of those kind of cumbersome administrative processes that are really a big factor for clinician burnout, what are some key risk factors, not that you would consider when it comes to adoption of AI in clinical practices?

00:12:23:03 – 00:12:35:06

Matt

Regardless of the use case, small or big, there's an associated risk, and it's important that it's articulated to the end users.

 

00:12:35:06 - 00:13:12:10

Matt

And as organizations think about policy, AI is meant to support human functions or decisions. It is not meant to replace it. So I've spent a lot of time and, you know, in recent months, traveling with providers across the nation to adopt ambient listening technology to automate their documentation within any of our. And when you sit down with the providers, I'm always very clear that the AI generated note is a draft.

 

00:13:12:12 - 00:13:42:13

Matt

The actions that the AI will recommend are proposed. It's critical that on the front end of the adoption, you really talk to, in this case, the physicians, about what the AI is and what it is not. It is not a replacement of your responsibility as a licensed professional to sign that note or to sign off on that medication or that prescription.

 

00:13:42:15 - 00:14:17:14

Matt

Right. So from my perspective, as we continue to get to the next level, the education of what artificial intelligence really is meant to be - an assistant, but not a replacement - is critical as we move forward. It's impressive what it is doing. Yet it's also important that clinicians, and end users of the I understand their responsibility. It still lies on them to sign off on as the human and the owner on really the impact of patient care at the end of the day, right?

 

00:14:17:14 - 00:14:52:10

Matt

So it's about putting the right controls in place so that you can control the AI and wrap your arms around it. You know, AI will, as I've mentioned, fabricate. There was actually an example from my book that I read around, asking that in this case it was for Da Vinci Three about how they knew, how did they learn so much about Metformin and the at that time, Da Vinci three replied with, I received a master's in public health and personal experience with diabetes in my family.

 

00:14:52:10 - 00:15:14:16

Matt

Well, they I did not actually receive a master's in public health. And so we kind of laugh about it when, you know, you're playing around at home with the power of what, you know, ChatGPT is or in this example, Da Vinci three at the time, but at that is an a hallucination of, you know, what the artificial intelligence is.

 

00:15:14:16 - 00:15:21:02

Matt

And so it's just very careful that you treat, like you do anything else in life with caution.

00:15:21:04 – 00:15:30:06

Mary Ann

Fantastic. So, Matt, what aspects of AI do you see adding value to help current processes to help transform health care?

00:15:30:09 – 00:15:43:04

Matt

I'm going to go back to my earlier number one opportunity that I believe right now. Current state AI has the opportunity to go advance.

 

00:15:43:06 - 00:16:16:18

Matt

And it's really providing an intelligent assistant to doctors and nurses to decrease administrative burden and to give some background that everybody knows about. But I've been on the front lines experiencing it in the practices, not at the corporate level or in the C-suite office, but in the provider practices that are doing, you know, every single day serving 25 plus patients in primary care, various specialties, etc. physician burnout is real.

 

00:16:16:20 - 00:16:36:14

Matt

And, you know, the administrative workload that has been put on to physicians and nurses, it has increased dramatically over the last 20 years. And candidly, it's diminished the noble desire of having young students enter into various health care roles to just help people because there's too much day to day documentation and paperwork. I've got to create these notes and insurance claims and requesting prior offers for lab tests.

 

00:16:37:16 - 00:17:04:04

Matt

It takes up 49% of a working day for doctors and nurses. So the net of this is that we need strategies to reduce administrative work on doctors and nurses to get back to what they do, provide patient care. And so, again, back to some of the things I've hinted at today automation versus augmentation, precision medicine, and some of these neat things that I am very excited about what it will be.

 

00:17:05:15 - 00:17:30:11

Matt

But my focus today, right now at Oracle Health is how can we automate administrative tasks to enable physicians, nurses and clinicians alike to get back to patient care? That is where we're going to see outcomes improve there. If you ask any provider - and I had the opportunity down in Knoxville, I won't mention her name, but a physician looked me in the eyes.

 

00:17:30:13 - 00:17:56:09

Matt

She's adopted our technology. She actually, has a four year old and a six year old, and she was telling me how on Sundays, she will spend anywhere from 4 to 5 hours doing documentation so that on Monday, she's not behind before she goes into the office. And she's got a full patient load. You know, tremendous, patient bedside manner.

 

00:17:56:11 - 00:18:22:07

Matt

And so, you know, she's a busy physician, bottom line. But still, I'm allowing her to spend time on Sundays that that 4 to 5 hours has gone down to 30 minutes to 1 hour. So the technology that we're providing to her is enabling her to spend four more hours per weekend with her four year old and her six year old.

 

00:18:23:09 - 00:18:50:15

Matt

And as a mom, that matters. And so what she told me, and she looks me in the eye as I was walking out of her practice, is. Thank you for contributing to the quality of care for my patients. And we have talked about, you know, her four year old and her six year old earlier in our meeting. But the bottom line is that there's direct correlation around physician satisfaction, linking back to patient satisfaction, engagement, and improved outcomes.

 

00:18:51:17 - 00:19:25:09

Matt

So if the physician is looking me in the eye, as opposed to typing on their computer, I feel engages the patient, I'm going to be more likely to remember what was said during the visit. I'm going to be more likely to follow through with the instructions that the provider has given to me. So I see the most important aspect of who are leveraging AI today, right now, in the near future, is getting clinicians back to what they were, what they went to school to go do, provide patient care.

 

00:19:25:11 - 00:20:00:08

Matt

It extracts across the entirety of a practice the health care system, the unit, you know, of a given floor. It's about addressing administrative burden. And that will bring attractiveness for young students to enter into health care again. Again, back to that noble desire strictly to help people. So in the near term, that's my focus to really bring back the joy of practicing medicine, I've had the pleasure to hear from countless providers on what this AI technology can really bring from Oracle and, getting them back to their practice and their patients.

 

00:20:00:10 - 00:20:09:05

Matt

And so that's, that's really it. I think in the short term, where the core focus should be and the excitement that is, AI's bring it into health care.

00:20:10:08 – 00:20:16:20

Mary Ann

Wonderful. Now, Matt, on that note, what excites you the most for what AI can bring to health care in the future?

00:20:16:21 - 00:21:01:23

Matt

So this is the art of the possible, right? And it does. You know, again, as I mentioned, I've had the opportunity to learn quite a bit about the capabilities that exist within Oracle's cloud. And other hyper-scalers have similar capabilities. It really, truly is endless around and to my earlier comment, overwhelming on what it is that we could go do, but to just name, you know, a few examples of really where I think and I'll, I'll go back to that automation versus augmentation to really getting to that augmentation aspect of what we can do to assist health care holistically, leveraging AI.

 

00:21:02:00 - 00:21:26:10

Matt

What I'm most excited about, and some of this is already starting to come out, with various entities. I think the impact is still, TBD around adoption, etc., but things like personalized medicine, how you can leverage AI to tailor treatments to individual patients by analyzing genetic information. Again, you know, there's a lot of interest there.

 

00:21:27:12 - 00:22:01:06

Matt

I don't necessarily know that it's being adopted across healthcare systems throughout the globe yet, but it's a very exciting on what I can bring there. And we're just scratching the surface. Medical imaging. So AI can be utilized to analyze medical images, to detect anomalies and aid radiologists in a, in a diagnosis that is very exciting so that a radiologist doesn't miss something if they're doing a night shift. Hypothetically.

 

 

 

00:22:02:06 - 00:22:33:04

Matt

Clinical decision support. So actually getting to the point that the AI can assist a health care provider for evidence based recommendations of patient care, how do you how does the AI potentially, you know, remind a provider or a nurse or a clinician of something they might have missed, right. Drug discovery. I think there's tremendous opportunity around what I can do to accelerate the drug discovery process.

 

00:22:34:06 - 00:22:57:00

Matt

Going back to, you know, the Bill Gates quote that I opened up with, how do you get ahead of significant things like we just went through in the pandemic? Well, AI can assist us in that as we think about what it can bring to the future. And, the other one, you know, to wrap in a bow is patient engagement.

 

00:22:58:02 - 00:23:23:09

Matt

I think that we all have our own ways of how it is that we want to engage with, you know, our own bodies, our own health care and AI powered chat bots. It can really know who you are, understand who you are, and how it is best to engage with you to get the best result of the engagement.

 

00:23:24:09 - 00:23:47:03

Matt

For - Are you doing your walking for diabetes right? Are you filling your prescriptions or not? Have you gone in for your annual wellness check? Are you going and seeing getting your dental exam on an annual basis? Small things that ultimately lead to more healthy populations and preventative care. I think AI has tremendous opportunity just through, you know, the scale of how it can actually analyze data.

 

00:23:48:05 - 00:24:09:21

Matt

It will take some of the pop health strategies and patient engagement strategies that exist today to the next level. So that's more getting to the augmentation aspect that I mentioned earlier, as opposed to just I think, you know, the core focus of automation, a process that we're that is the more of the here and now today. So, exciting times, a lot more to come.

 

00:24:10:23 - 00:24:20:03

Matt

And, I truly do believe that we're just scratching the surface of what artificial intelligence will be able to bring to health care. As we look back ten years from today.

00:24:21:05 – 00:24:26:11

Mary Ann

 I'm sure looking forward to seeing what comes next. Matt, thank you so much for joining us today, and thanks for sharing your insights with us.

00:24:27:14 - 00:24:40:21

That’s all for this episode. 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.

 

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.

As society’s focus on mental health intensifies, technology stands at the forefront of this evolving narrative. Listen in as this group of experts examines technology’s paradoxical role in mental wellbeing: constant connectivity that reveals insights yet also increases burnout due to poor design, and social media, where overuse is linked to decreased mental health but provides a beacon of hope through innovation. Hear about the challenges and opportunities of using technology to enhance mental health, exploring how digital advancements can be harnessed for a healthier, more balanced future.    Featuring the following panel at SXSW Conference: Moderator: David Feinberg, M.D., Chairman, Oracle Health Danny Gladden, MBA, MSW, LCSW, Director, Behavioral Health and Social Care, Oracle Health Tracy Neal-Walden, Ph.D., Chief Clinical Officer, Cohen Veteran Network Michelle Patriquin, Ph.D., Director of Research, Associate Professor, Menninger    Listen as they discuss:

• The moment realized, that access to care needs to be fixed (0:40
• What is happening from a technological standpoint that is helping individuals, patients, families, and communities (4:33)
  • The use of iPads
  • Research assistance
  • The collection of outcomes data
• An example of something done based on data to change the way that care is delivered (6:20)
  • The role of sleep
  • Post-treatment and post-discharge risks
  • Q15 (15-minute patient safety) checks
• Example of the effectiveness of telehealth (9:15)
  • Prior and post-pandemic
  • Impacts on standard measures
    • Additional data insights
  • Impact on no-show appointments
• Using technology to tell a fuller story (12:45)
  • Wearable devices
  • Digital therapeutics and inputs
  • Research to practice gap and the potential of technology (15:38)
• Concerns with technology not helping or distracting from human connection (17:05)
  • Social media and the link to depression (17:50)
  • People who are left behind; technology access and literacy (19:00)
  • Psychologic safety of technologies (20:00)
  • Concerns from the clinician perspective (20:45)
    • Helping clinicians with documentation and proper training of tools
    • leveraging AI (21:44)
    • Clinician burnout (22:34)

Notable quotes:  “This is why I love wearables, and I’ve always loved wearables, psychophysiology, because it fills a tremendous gap in our ability to measure the dynamic fluctuations and the way our emotions and behaviors change.” Michelle Patriquin, Ph.D., Director of Research, Associate Professor, Menninger (15:10)   Learn more about how Oracle behavioral health solutions combine real-time clinical data from across each patient’s unique healthcare journey.   Watch on-demand and live webcasts by registering for Oracle Health Inside Access.   --------------------------------------------------------   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.

00:00:11

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.

00:00:34

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.

00:01:01

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.

00:01:22

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.

00:01:40

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?

00:02:03

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.

00:02:30

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.

00:02:47

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

Be sure to subscribe to Perspectives on Health and Tech podcast for more insights from industry experts, visit Oracle dot com slash Health or follow Oracle Health on social media.

 

 

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:

• Moderator: Nasim Afsar M.D., MBA, chief health officer, Oracle Health
• Christy Dueck, Ph.D., global head of the Learning Health Network and Health System Activation, Oracle Health
• Esther Gathogo, M. Pharm., Ph.D., senior performance improvement leader, Oracle Health
• Sarah Matt, M.D., MBA, vice president, physician and healthcare technology executive, Oracle Health

Listen as they discuss:

• Many women prioritize others’ care above their own needs. What are ways technology can partner with providers to ease this burden? (2:49)
  • Clinical trials
  • Patient engagement and automation
• When patients feel like they aren’t being listened to, they might seek alternate options. 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? (8:53)
  • Providers need to re-educate on other modalities
  • Patient education 
  • Social determinants of health data in the EHR 
• How can we bring data together to proactively help communities that are exposed to higher risks? (12:43)
  • Using data to identify populations preventatively
  • Digital therapeutics
• What are some other ways you’ve seen health organizations share info with their communities? (19:56)

“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:

• Moderator: Nasim Afsar M.D., MBA, chief health officer, Oracle Health
• Christy Dueck, Ph.D., global head of the Learning Health Network and Health System Activation, Oracle Health
• Esther Gathogo, M.Pharm., Ph.D., senior performance improvement leader, Oracle Health
• Sarah Matt, M.D., MBA, vice president, physician and healthcare technology executive, Oracle Health

Listen as they discuss:

The moment they realized, personally or professionally, there was a gap in women’s health care (2:47)

• In practice for oncology patient
• Collegiate athlete performance
• Menstrual health care in school settings
• In practice, while pregnant

What is being done to address the lack of research on women and diversity amongst women (10:56)

• Representation in clinical trials
• Product development
• Expanding inclusivity in EHR data

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)

• Tips for training AI algorithms
• Burnout, patient engagement, automation

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.

---------------------------------------------------------

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

• Waleed Ahmed, Senior Manager, Cloud Engineering, Oracle 
• Esteban Rubens, Field Chief Technology Officer, Oracle Cloud    

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.