Perspectives on Health and Tech – Détails, épisodes et analyse

In this episode of Perspectives on Health and Tech, Oracle Health welcomes Shelagh Maloney, CEO of Digital Health Canada, for a forward-looking conversation about how Canada can build a more connected, equitable, and digitally empowered healthcare system. From advancing interoperability and clinician mobility to exploring the role of artificial intelligence in care delivery, Shelagh shares insights from Digital Health Canada's AI in Action initiative — including the "winning conditions" needed to deploy AI responsibly and inclusively. Together, we explore how technology, policy, and collaboration can unite care across provinces, empower citizens with access to their data, and help clinicians deliver smarter, more human-centered care from coast to coast to coast.   -------------------------------------------------   Episode Transcript:

00:00:00:00 - 00:00:44:03

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 health care world where everyone thrives. Let's get started. Welcome to the Perspectives on Health and Tech Podcast, brought to you by Oracle Health. I'm Larry Sylvestre and today we're exploring one of the most defining challenges and opportunities in Canadian health care: interoperability.

 

00:00:44:04 - 00:01:13:04

From enabling clinicians to practice across provincial lines to giving Canadians direct access to their health records, interoperability is key to building a truly connected health system. Joining us today is Shelagh Maloney, the CEO of Digital Health Canada, an organization at the heart of advancing digital health, professional development, and policy collaboration across the country. Shelagh, thank you for being here.

 

00:01:13:05 - 00:01:38:05

Before we dive in, could you tell us a bit about your vision since taking on the CEO role earlier this year? Well thanks, Larry. First, let me start by saying how thrilled I am to be on your podcast. I'm looking forward to the conversation. And yes, I did join Digital Health Canada. It's been almost a year. I joined at the end of January 2025 and it's been a whirlwind.

 

00:01:38:05 - 00:02:04:08

And Digital Health Canada, like other, you know, national associations that we really want to provide value to our members. We have networking events and we have influence health policy. We look at advocating for the profession. And, you know, one of the things that I'm excited about is that we've just launched a strategic plan to 2030.

 

00:02:04:11 - 00:02:22:06

 

And so a big component of that is going out and asking our members what Digital Health Canada means to them and what they're looking for. We're doing some work in the governance space. I think education is trauma, endless possibilities now, and particularly as AI is getting so big. And I know we're going to talk about that later.

 

00:02:22:08 - 00:02:47:10

And of course, advocacy for both professionals and the profession at large. That's a perfect set up for our discussion, Shelagh. How can Canada move forward from our fragmented systems to a pan-Canadian model of care that's equitable, citizen centric, and digitally connected? One of the biggest conversations right now in health care is around nation building, breaking down barriers between provinces and territories.

 

00:02:47:12 - 00:03:14:01

What are you seeing from your standpoint at the leadership role at Digital Health Canada? You know, this is such a timely question and I'll tell you why. Yesterday we had a conversation with, Doctor Anderson Chuck, the CEO of CIHI and Doctor Fahad Razak, who is the among other things, does a role at Unity Health, in Toronto, but also is the Canada research chair and data informed health care improvement.

 

00:03:14:03 - 00:03:34:00

And it was really interesting. And one of the things we talked about was, and, you know, you and I know this, it's not a technology issue that we're dealing with in terms of interoperability and connected care, but it's a cultural issue. And it's really interesting that, that's a different sort of change in our thinking a little bit.

 

00:03:34:02 - 00:03:58:22

But certainly, one of the big challenges in a federated system, having a national perspective and doing things at that large national scale is more of a challenge than we would hope that it would be. Yeah. Certainly the landscape is full of different perspectives on how to proceed. And sometimes some of these conversations do get politicized.

 

00:03:59:00 - 00:04:27:16

But certainly it's great to see, I think some of the federal government perspectives and agencies coming together to try and be facilitators in this discussion. And I think, Canadians in general are ready for us to meet that challenge head on. So it's really inspiring to hear how we're aligning policy and technology and how those things could potentially unlock the possibilities for clinicians and ultimately, better continuity of care for patients.

 

00:04:27:18 - 00:04:51:01

Let's turn a little bit to the citizen side of the discussion. How does a citizen first approach align with work happening in Canada now? Well, you know, it's kind of interesting in like 2012. So a while ago and this was all the rage when, when patient engagement and patient partners were just sort of, I think coming into mainstream.

 

00:04:51:07 - 00:05:09:00

Some may argue they're not quite mainstream yet, but that was where the hype really started. And it was Leonard Kish who was an IT strategist in the US. And I remember and you might remember this, Larry, there was a famous quote that he said if patient engagement was a drug, it would be the blockbuster drug of the century.

 

00:05:09:02 - 00:05:43:05

And so that has been frequently, you know, bantered around. But the rest of the sentence that I really love is and it would be medical malpractice not to use it. And I know and you know, my former roles at Canada Health Info way and CIHI, we did a lot of research in this area. And we know that patients, when they are engaged, when they are part of their, has access to their health records and can see their information and know where they are in the queues, they are more informed about their health care, they are more confident in the care that they receive, and they have better relationships with their care

 

00:05:43:05 - 00:06:09:13

providers. And all those things together mean that their outcomes are better. So we know it is. There's evidence to demonstrate that engaging patients in the process and including them, as we're developing systems, etc., will make a difference to health care. Agreed. Certainly, when we look across the country and reflecting back on, you know, just the previous question to answer that we corresponded on.

 

00:06:09:15 - 00:06:32:04

As you look across every province and they have their own health legislation and different policies, procedures, approaches to health care delivery, etc. It really is a bit of a thicket and even the best facilitators in that have failed historically to move the needle and hopefully we're in a much better position now to understand what the challenge is, how we can move it forward.

 

00:06:32:05 - 00:06:54:23

What was fascinating to me is, as you and I were both at the Infoway Partnership Conference recently was a stakeholder from Portugal who was on stage talking about how they put the patient at the center of interoperability around consent and that they adjudicate which clinicians in the care team are going to have access to their records, and that they have the opportunity to even rescind that.

 

00:06:55:01 - 00:07:23:09

Do you see that having any potential in Canada? Maybe not in whole, but perhaps in part? My desired answer would be to say, absolutely yes. I think we are getting there, and I think we would love to have that. And I think, frankly, patients and their family, we're getting a little bit impatient, and asking the questions if they don't think that it's already there, it's like, what do you mean

 

00:07:23:09 - 00:07:55:15

my specialist and my GP are not exchanging information? What do you mean the emergency department and the clinic don't have the same information? And so, I think we're recognizing that we need to get there. And frankly, one of the things that we're seeing is patients increasingly are using ChatGPT and other models, and they're collecting their own information and creating their own health records, because nobody else is doing it and the system is failing them in that regard.

 

00:07:55:17 - 00:08:18:21

So, you know, if we don't do it for patients with patients, I'm afraid, and rightfully so, they'll find a web mechanism to do it on their own. And that, from a health system perspective, won't be helpful because, you know, the care providers, etc. may not have the information that they need to provide the best care that's available to a patient.

 

00:08:18:23 - 00:08:57:23

It's excellent point. And that draws me in to sort of another sort of another train of thought about the data is the data. And, you know, there are a lot of constituents across the care continuum who feel like they're living on little islands of data and perhaps not connected with others. And as we talk about building a pan-Canadian infrastructure to enable the mobilization of that data, you start to think about artificial intelligence in that conversation, not only for the sake of the institutions and clinicians who need to deliver care, but for the individuals themselves.

 

00:08:58:01 - 00:09:32:13

And that becomes particularly material in Canada, where we have one of the lowest population densities on the planet, and we have a very challenging time providing equitable care to this broad and diverse population and massive geography. And so moving the data to the clinicians becomes, you know, paramount to being able to deliver effective care and enabling the patient themselves to have access to their own data so they can leverage AI for their own purposes, might also be a complementary sort of perspective around the movement of data.

 

00:09:32:15 - 00:09:54:01

Do you have any thoughts on that and how we're progressing as a country relative to those points? Really, we're in such interesting times, aren't we, with the AI? And one of the things that is challenging is the pace of change. And we hardly see that in healthcare. But the pace of change, we're accelerating on a timescale of not years but months.

 

00:09:54:03 - 00:10:16:13

And so we just have such a tremendous opportunity. And, you know, you make the case like Canada has one of the most diverse populations in the world. And when you think about AI, it runs on data. And so having a diverse population where you can scale and implement things in one region to another, you know, with some differences.

 

00:10:16:13 - 00:10:39:19

But that's a tremendous opportunity for us. And we've got, you know, a large country, 45 million. It's not huge. And then the data that we do have, it's a diverse data set. It's not just insured or uninsured. We don't separate data that way. And so there's so much opportunity in Canada. And, you know, the other thing that we have is, scientific talent here.

 

00:10:39:19 - 00:11:00:12

You know, we have a Turing Prize, a Nobel Prize winning for AI. They are Canadians. And so we've got so much potential in Canada. But one of the things that, you know, one of the big five consulting firms did a study a few years ago, and they looked at about 47 countries, and they looked at AI literacy and training for their populations.

 

00:11:00:17 - 00:11:26:00

And they looked at trust in AI. And Canada scored, you know, 42, 43 out of 47. So we're way down at the bottom. So I think that's what, you know, trust comes up in these conversations all the time and culture comes up. So we need, I think, as a nation to really empower everybody and build trust in AI and use it effectively.

 

00:11:26:06 - 00:11:51:14

And so, you know, we just the federal government has introduced the minister of Artificial intelligence. That's a really significant move. Let's see what happens with that. So I think there's tremendous opportunity in Canada. But there are other countries who are leapfrogging above us. And we need to really think strategically, about how we do this. And I think that collaboration and partnerships and a singular focus is going to help us and get there.

 

00:11:51:16 - 00:12:15:23

It will help significantly. Absolutely agreed. And well said, Shelagh. I've heard you mentioned in the past a winning conditions report for AI adoption. And I also know that Digital Health Canada has done an AI in action environmental scan. Can you talk to us a little bit about those two topics and how they relate to what we're conversing about today?

 

00:12:16:01 - 00:12:38:02

Yeah. Thanks, Larry, for giving me the opportunity to say that. So it was published in May of this year. We went out to about how eight leading health care organizations across Canada hospitals, health authorities, whole provinces. And these are the folks who are sort of a little at the leading edge in terms of using AI in in clinical settings and in health care.

 

00:12:38:04 - 00:12:56:22

And, and we interviewed them and sort of asked them not about what they're doing, but we asked them what were the winning conditions and what did you need to have in place. So we talked about things like risk management. We talked about governance. We talked about, you know, safety and security. And so there was a not everybody approached it the same way.

 

00:12:57:00 - 00:13:17:23

But a couple of key things came through. And, you know, the strategy was, you know, you have to address a real world problem. It has to be a big problem. Don't use AI for the sake of using AI. Use it to address something that you're significantly involved in. And then your risk management, your risk tolerance is different.

 

00:13:17:23 - 00:13:35:06

Some of the big, larger hospitals have more risk tolerance and have more, frankly, expertise in doing this. So it was it was really it's an interesting read. It's available on the Digital Health Canada website free of charge, maybe 12 pages. So it's a it's an easy read as well. So I'd really encourage listeners to take take a look at that document.

 

00:13:35:08 - 00:13:57:23

And then just in, gosh, just a few months ago, we released this AI Environmental scan. So we went across the country and asked people to and did an of review of, AI in clinical settings only. And what projects were there and that we were available and that we could see publicly. And there were about 152 projects.

 

00:13:57:23 - 00:14:14:15

And since then, I should say a number of people have seen this report and said, you know, I'll add this one at this one. So we're up to about 170 or so. So we did that across Canada AI in clinical settings. And it was really interesting that one of the sort of I won't bore you with all of the details.

 

00:14:14:15 - 00:14:44:05

And again, this information is available on the website. But one of the thing that was most interesting to me that, about 59 or 69% of the projects were in pilot state. And so that's, you know, and that's not going to surprise anybody in health care in Canada with our pilot ideas. But, you know, that's so is it a reflection of we're just beginning in this field or is a reflection of our failure potentially to, to scale as a nation?

 

00:14:44:07 - 00:15:05:23

Yeah, it's a conundrum, isn't it? It's, cautiously optimistic and slightly risk averse is kind of how I would measure the temperature of Canadians right now is with respect to AI. You hear about the incredible potential, but you also hear some of the scary stories that go along with it as well. But I think you use the word very astutely, and it's the word trust.

 

00:15:06:04 - 00:15:43:23

As we move forward, we all have to really think about how to garner trust and ensure that the systems that are, being advocated for, really deliver on that promise, because I has incredible potential to make health care more equitable and efficient and human centered. But realizing that potential will all come down and depend on collaboration to move the data, transparency about how the black boxes work and shared trust again, it's exciting to see how Digital Health Canada and partners across the ecosystem, including Oracle Health, are laying the groundwork for responsible, data driven innovation that benefits every Canadian.

 

00:15:44:01 - 00:16:06:17

Shelagh, thank you so much for sharing your valuable insights and for your leadership at Digital Health Canada. Absolutely delighted to be a participant of that organization for many years. And so, thankful that you were in a leadership position there after your many years of great service from across the health care system. Before we close, would you like to leave our listeners with one takeaway?

 

00:16:06:17 - 00:16:29:16

What should we, as an industry and as Canadians, focus on to make this vision of connected, equitable and AI enabled health care real? Well, so first of all, thank you, Larry, for inviting me to participate. And then I really enjoyed the conversation, and I really appreciate the leadership that Oracle is showing. Not only, you know, in putting this podcast forward, but really, in the industry.

 

00:16:29:16 - 00:16:54:13

And so certainly, a firm that we are very happy to have included in our membership at Digital Health Canada. And, you know, I think, it's organizations like Oracle and associations like Digital Health Canada, we have I think, a responsibility as leaders in this space to really promote that one Canada approach and really lead the way in changing.

 

00:16:54:18 - 00:17:24:14

I think it's a culture shift. You know, health can be an economic driver. And this is a data that we have was a real natural resource. And so changing the mindset, I think would be really important for us to do. And I maybe I'll leave that challenge with our listeners and of their. Yeah, absolutely. And I think the messaging out of our federal agencies aligns very much with what you had just stated.

 

00:17:24:16 - 00:17:53:15

But there's an opportunity for Canada. It's one that can be both enabling for all of our health care journeys and potentially one that can help us fuel innovation and, perhaps potentially even fuel some domestic agency and industry to go alongside it. So in closing, I just want to say that at Oracle Health, we believe interoperability isn't just about connecting systems, it's about connecting people, provinces, and possibilities.

 

00:17:53:17 - 00:18:22:03

As AI and digital innovation continue to reshape health care, collaboration across technology, policy, and care delivery will be key to ensuring every Canadian benefits from a connected, data driven, and equitable health system. Thank you again, Shelagh, for all of your contributions today and over the course of your fantastic career. That's all for this episode of Perspectives on Health and Tech Podcast.

 

00:18:22:05 - 00:18:52:03

Thank you for listening, and join us again for the next insightful episode of Perspectives on Health and Tech. 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/Health and oracle.com/life-sciences, or follow Oracle Health and Oracle Life Sciences on social media.

 

00:18:52:05 - 00:19:04:00

Thank you for listening and join us again for the next insightful episode of Perspectives on Health and Tech.

 

 

Leading organizations share how data-driven innovation transforms care delivery and patient outcomes. In this Oracle Health and Life Sciences Summit 2025 keynote, Alaa "AJ" Adel, Senior Vice President of Oracle Health International, joins distinguished leaders from West Suffolk NHS Foundation Trust in the United Kingdom, Bajaj Group in India, King Faisal Specialist Hospital & Research Centre in Saudi Arabia, and Western Health in Australia. Together, they reveal how hospitals and health systems are designing the future of care through artificial intelligence, advanced data strategies, and radically human-centered solutions built on Oracle technology. Hear real-world stories from West Suffolk NHS Foundation Trust, Bajaj Group, King Faisal Specialist Hospital & Research Centre, and Western Health as they share how Oracle Health is helping each organization reimagine hospital infrastructure, improve patient engagement, and drive operational excellence. Understand how this global perspective unlocks new, scalable healthcare models for a connected, healthier world.

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Episode Transcript:

00:00:00:00 - 00:00:37:14

Welcome to Perspectives on Health and Tech Podcasts, brought to you by Oracle Health, where we dive deep into the world of innovation and transformation in healthcare. 

 

00:00:37:16 - 00:01:18:11

Shanna Adamic

I'm your host Shanna Adamic, Director of Oracle Health Executive Content and Video. In this episode of Perspectives on Health and Tech we feature a panel discussion recorded at The Oracle Health and Life Sciences Summit held in Orlando on September 10th, 2025. In this discussion distinguished leaders from West Suffolk NHS Foundation Trust in the United Kingdom, Bajaj Group in India, King Faisal Specialist Hospital & Research Centre in Saudi Arabia, and Western Health in Australia reveal how hospitals and health systems are designing the future of care through artificial intelligence, advanced data strategies, and radically human-centered solutions built on Oracle technology. 

 

00:01:18:17 - 00:01:47:18

The discussion is led by AJ Adel, Senior Vice President of Oracle Health International. 

 

AJ Adel

Good afternoon. Today I get the pleasure of presenting four leaders from four different continents with six time zones. Don't ask me about the math. That's what we came out with. The topic of discussion is AI on a global scale. As we are traveling around the globe and we're visiting our clients, we get to see the cool things they all do, and they all work on.

 

00:01:47:20 - 00:02:09:17

So today, I have the pleasure of presenting those leaders who are thinking about things differently, whether they're building a hospital or delivering care or just engaging with their patients. They have a different view on things. So, I'm super excited to introduce them all on stage. I already told them we're going to change the questions. But what I didn't tell them is, we're all friends before anything else.

 

00:02:09:19 - 00:02:33:16

And we all decided this is going to be the most fun session ever. Let me start with you, Kathy. You. You come from King Faisal Hospital, a huge organization in Saudi Arabia, doing amazing things, serving 20% of the population of Saudi.

 

00:02:33:18 - 00:02:53:17

And you're keeping the patients and the people at the center of everything you do. When you put the patient at the center of your design, it's not always easy. Can you share? And what are some of the challenges you're facing when you're actually just focusing on the patient? 

 

00:02:53:18 - 00:03:28:15

Kathy Sienko

Delighted to be here from King Faisal Specialist Hospital. The one thing we know is that, even though we are largely an Islamic society, not all of our patients are homogenous. And as we think about how we design around patients, the first thing is really understanding what do the patients actually want and how do we use the data that we have around our patient's experience to tell us what's working and not what's not working for them, and how do we factor that into the design of services.

 

00:03:28:16 - 00:03:57:17

Kathy Sienko

The other bigger problem, I think, is really moving from the rhetoric to the practicality. We all say that we want a better patient experience. We want to build our services around patients, but the provider workflows need to change in order to make that happen, to facilitate that. And that's not always so easy to change when people have been doing something the same way for many, many years.

 

00:03:57:18 - 00:04:19:14

Kathy Sienko

So, we are 50 years old this year, believe it or not, and some of our people might even have been there for nearly all of that time. And so, getting those changes into practice, moving from the rhetoric of what we'd like to do to actually making the physical changes to the way that we work from a provider centric model to a patient centric model, is one of the challenges we have.

 

00:04:19:14 - 00:04:47:07

Kathy Sienko

And then there is the question about the technology that supports that patient journey and the integration between solutions, that actually makes that patient's experience very, very different. But we also think about it in terms of design. How do we design facilities to be healing and healthy environments as well. So, we think about fine details like color and artwork and all of those sorts of things.

 

00:04:47:07 - 00:05:11:15

Kathy Sienko

But perhaps important to know about King Feisal is that we are a specialist tertiary organization, quaternary even. And so, we see people who are really at, the most serious stage of their disease. And that actually drives for us as we think about our patient innovation, because we really want to do a great job for those patients. For many of them, we are their last port of call.

 

00:05:11:17 - 00:05:32:14

Kathy Sienko

And so, it really drives a lot of innovation. It features in things like clinical trials. And we actually are running about 48% of all of the clinical trials in Saudi Arabia at King Faisal Hospital. So, it drives a culture of innovation and wanting to do more and better but of course, there is the cultural change that needs to happen.

 

00:05:32:16 - 00:05:57:17

Kathy Sienko

And then there is also the technological workflows that actually support the kind of work that we want to do. So, as you say, it's not easy work. It's culture change and technology change. It's change that really focuses on why we are here. And we really are there for the patients. And so, we follow through on that as a philosophy into practice.

 

00:05:57:19 - 00:06:16:03

AJ Adel

I've been visiting King Feisal for the last 15 out of the 50 you mentioned, and I've always looked at how all the leaders have one thing in common. Every vision has the patient at the center of it. So that's amazing. Russell, every time I open my LinkedIn, I see you building a hospital.

 

00:06:16:05 - 00:06:34:05

Russell Harrison

Not me personally. 

 

AJ Adel

No. Not you. Well, I do see you with the hoodie and the vest and everything, but you're also, down in Australia. You're changing healthcare, and you're going to places where healthcare hasn't been before. But you're also doing it while keeping the patient at the center of this. Can you share your vision?

 

00:06:34:05 - 00:06:50:22

Russell Harrison

Yeah. I just say we're quite fortunate, you know, why build one new hospital? One. You can do two at the same time and two little ones. So, four in total. But that's just for that. Population is growing so quickly. And for me, I don't disagree with what Kathy said, but I'm going to come out from a different angle.

 

00:06:50:22 - 00:07:11:16

Russell Harrison

And as part of that build, we've seen the opportunity to put our patients and our staff at the center of how you design a new facility. And that's been quite challenging because a lot of the guidance is written for ten years ago, and our staff and our patients are imagining a new world, about what they want and how they want the workflows to work.

 

00:07:11:18 - 00:07:38:10

Russell Harrison

And that's been quite challenging, going against the sort of the building regulations, they're not true regulations, but they're sort of guidance notes to actually put our staff in fabulous facilities with light and our patients in rooms with light, not the old hospitals we've got. So, it's been great to be able to do that. And through the process, the technology has changed because, you know, no offense to many clinicians, myself included, you cannot read a plan and imagine what a room will be.

 

00:07:38:12 - 00:07:53:21

Russell Harrison

But with AI and modelling, you can kind of get a sense of how that will look. We are in a room this sort of size and it was all on the floor, and you can move walls around. So, using technology in the design really allows us to put our staff and our patients at the center and actually then feel what that facility will look like.

 

00:07:53:21 - 00:08:19:07

Russell Harrison

So, our aim is that we get a much better facility that our staff want to work in, can work in, and our patients can be cared for in a very different environment that's healing and light, and hopefully they go home. They don't want to stay forever, but, it will be a much better experience. And I think, you know, that's the important bit about how we can design new facilities and use technology to help do that, rather than just kind of go off a plan and go, "Well, that's what you get." 

 

00:08:19:07 - 00:08:52:22

Russell Harrison

Let's challenge that and let's get the clinicians and patients pushing for the same thing. 

 

AJ Adel

Yeah. You also had a couple of go lives recently. And I remember you; you're calling up and saying, "We need this, this and this because the patient needs it. That's what I want. And I want that for them, not for me." Moving to the Nirav. The Bajaj Group is into a lot of things, but recently into healthcare. You've done - when we did the math- 35 visits around the globe to multiple healthcare facilities, government entities and beyond looking at the best view of what the future looks like.

 

00:08:53:00 - 00:09:09:06

AJ Adel

So, in many ways, you do have a crystal ball. You can look into the future. What have you seen looking into the future? How does the hospital of the future look like as you've seen it, as you design it in your mind? And I still remember the video you showed us on how things would look like.

 

00:09:09:12 - 00:09:31:05

AJ Adel

You're literally doing it from scratch based on the previous experience of others. Would love to hear from you on the hospital for the future for you. 

 

Nirav Bajaj

Thank you for staying on script. So, the way we look at it, we've been to four continents now. We've been looking at all the different so-called best facilities in the world.

 

00:09:31:06 - 00:09:54:07

Nirav Bajaj

The way we've structured our organization is we want to focus on prevention and be proactive rather than reactive. And I think that's something that, honestly, is what the future is. Because you want people to stay healthy. You want positive health rather than dealing with people who are unwell and get them to that stage. The other thing is it's actually an ecosystem.

 

00:09:54:11 - 00:10:13:16

Nirav Bajaj

So, I don't look at it as a hospital. I look at it as an ecosystem to even get prevention and be proactive. You need to have them in the entire continuum. You have to build the entire continuum of care. So right from home to home and everything in between. And many people say that, okay, you're building clinics, you're building ambulatory, and that's a feeder to the hospital.

 

00:10:13:18 - 00:10:30:13

Nirav Bajaj

The way we're looking at it is the hospital is a feeder to the clinics, because the clinics are going to be in your localities close to your home. You recover better when you're at home rather than when you're in the hospital. So, we think of it as an ecosystem rather than thinking of it just as a hospital or as a clinic.

 

00:10:30:15 - 00:10:51:04

Nirav Bajaj

And lastly, as I think that it's going down to the trend of, personalized care and personalized medicine, and we look at it even from the logistic point of view. So why can't we, for example, we know when you've entered our campus, we've already allocated a parking spot for you. We already put you in the queue for your OPD appointment.

 

00:10:51:05 - 00:11:24:20

Nirav Bajaj

And the same with IPD is why can't we have you already checked in to the room? Because we know you're on our campus. You'll be there in a few minutes. That's on the logistics side. On the medical side, which is human, which body is different and reacts different to the same medicine. So why can't we understand what your genetic sequence is and see how you react to this medicine, whether through a digital twin, which, of course, now AI is playing a big role in, or just understanding you better emotionally and mentally.

 

00:11:24:22 - 00:11:48:07

Nirav Bajaj

So that's how we're looking at the future of healthcare. 

 

AJ Adel

I think we're going to start calling hospital for the next 19 minutes the ecosystem. And I love what you said. It's going to feed the clinics, not the other way around. Russell, with the construction you all are doing. Are you looking at things differently?

 

00:11:48:07 - 00:12:07:10

Russell Harrison

Well, we're trying to. Hospitals usually are not places for community to come unless they're unwell. And we're trying to spin that to make our new facilities actually a community resource. I might pinch that one but much more about the community can come in and not use the facilities but get the benefits of the fact that a health precinct is there. And that's about -- sort of some message about primary prevention. 

 

00:12:07:10 - 00:12:28:12

Russell Harrison

There will be GPs there. There will be sort of primary healthcare providers. We're also -- and it's strange for an acute hospital to do this. But we're building kind of a new twist on a day hospital. So chronic condition patients can come in. They can get some peer support. So, we've employed lots of lived-experience workers, both mental health and physical health. 

 

00:12:28:14 - 00:12:52:13

Russell Harrison

We've got carer-support workers that are carers themselves that have been through the process. You can see your clinician. You can talk to a peer. You can talk to AI, hopefully, if you can deliver it for me, AJ, No challenge. Can we have it, yesterday?

 

AJ Adel

He had to put that in there. 

 

Russell Harrison

Got to do it. But it's about how do we actually get people coming in to try and get into that primary prevention space, rather than have to come to an ED and get stuck in a system?

 

00:12:52:15 - 00:13:13:01

Russell Harrison

So how can we get patients to engage, you know, to self-drive their own care to peer-peer support and become those future leaders and community, take messages out to the wider community? So, we're careful about what outlets we let there in terms of food and, you know, dietary nutrition intakes. So, I think we're trying to come at it slightly differently.

 

00:13:13:01 - 00:13:30:09

Russell Harrison

It's a bit of a sort of experiment but our community kind of saying they want that. And they want to sort of be in the hospital, but not an inpatient facility but just use that as a community resource to actually bring that health and wellbeing back into our communities. 

 

AJ Adel

Yeah. Giving the patient the control and giving them the options.

 

00:13:30:09 - 00:13:51:15

Nirav Bajaj

I think, historically -- sorry to pitch in -- it's always been a place that you want to avoid versus making it welcoming. And then it makes me think back to, when your car needs service, you always go on time.  But when your body needs service, you try to procrastinate and delay it until it's too late. So, I think making it a welcoming space makes it a big difference.

 

00:13:51:15 - 00:14:13:01

AJ Adel

Agreed. Great. Speaking of making it work, Nicola at the NHS, there's a lot of history. There's a lot of, process. Let's just say that. But every time I talk to you, you're thinking of new ways to deliver care. Can you share a little bit of examples of what new ways that are you looking to deliver care today as we step into the future?

 

00:14:13:03 - 00:14:44:12

AJ Adel

And is that making an impact to the patient, to the hospital operations? What's your view so far? 

 

Nicola Cottington

Yeah, sure. So, I'm as a Chief Operating Officer, I'm really interested in how we make not only the hospital, but how healthcare system work more smoothly. But that is only for the benefit of the patient. So, I often when I describe my role, I say, you know, the value that patients get is when they meet with their clinician and the operational team and the logistics team are there to make that happen as smoothly as possible.

 

00:14:44:14 - 00:15:07:13

Nicola Cottington

So, we're also building a new hospital. It seems like everyone's going to a new hospital.

 

AJ Adel

We're going to call it an ecosystem. 

 

Nicola Cottington

But exactly because, well, I'll come on to that, actually. And our hospital is also currently just over 50 years old and in West Suffolk we need to build a new hospital because there's lots of problems with the construction of it, and we've had to do a lot of remedial work.

 

00:15:07:15 - 00:15:30:22

Nicola Cottington

But when we're thinking about our new hospital program, we've actually called it our Future System program, coming back to that system of care, because in order to make a hospital run smoothly, we need the community services to be running smoothly. And we need to support patients to be able to get the same experience that they would experience in a hospital, but in their own home.

 

00:15:30:22 - 00:15:52:01

Nicola Cottington

So, we've put in place a virtual ward, for example. We have used some remote monitoring technology. But some of it is also just about how we encourage people to feel as safe and secure as they do in a hospital. So yes, people put off coming to a hospital, but actually people also see it as a bit of a safe space.

 

00:15:52:03 - 00:16:14:17

Nicola Cottington

They feel safe. They can see the nurses and the doctors, and we want to create that same feeling. But out there in the community. So, we already run community health services as well. So, we have some experience of that. And we have a team called our Early Intervention Team who take patients and go and visit patients who are diverted from ambulance calls.

 

00:16:14:21 - 00:16:39:18

Nicola Cottington

So, somebody might call 999, as it is in the UK. That's triaged by an unscheduled care hub. And our early intervention team will go out and see that patient rather than a paramedic team, if that's appropriate. What I'm interested in is, as we move forward, how do we use AI to perhaps inform some of that decision making and to automate some of that with the relevant safety checks in place as well?

 

00:16:39:18 - 00:17:07:14

Nicola Cottington

Of course. But so that we are making the best use of our resources so that we are protecting our high acuity resources for those patients that really, really need it and really need our emergency department care. 

 

AJ Adel

Well, we're definitely going off script now in a good way. Kathy, I know for a fact King Faisal had done no harm initiative a couple of years back, which back to what was Nicholas saying, you want to make it a safe place.

 

00:17:07:14 - 00:17:26:07

AJ Adel

Eventually you have to go to the hospital, right? And eventually you have to be treated. But you want to make it a safe place. You want to make it a place where people feel comfortable being vulnerable. Right. What's King Faisal doing to ensure new ways of delivering care? You're innovating. You're always sharing a new vision.

 

00:17:26:08 - 00:17:54:11

AJ Adel

Where are you right now? 

 

Kathy Sienko

So, this is one of the best things about being at King Faisal is that there's a huge ambition and a commitment to innovating for patients. And one of the things that we really focus on is how do we enable our clinicians to practice at the very tops of their licenses, and that involves removing from them parts of the workflow that could be done through AI or through technology.

 

00:17:54:13 - 00:18:19:00

Kathy Sienko

It also means for us, keeping people at home because we know that quite a lot of hospital, a lot of infections are acquired in hospitals. As part of our zero-home initiative, our home healthcare is a big part of that. We know that for some patients, it is safer for them to be in their home environment than to actually be in a hospital environment, particularly because of the patient population that we serve.

 

00:18:19:00 - 00:18:40:22

Kathy Sienko

A lot of oncology patients. We have one of the biggest liver transplant programs or transplant programs in the world. We do quite a lot of, high, complexity neuro cases, etc. So, we think about where the safest place for those patients is to be, and also how can we assure their safety when they come into hospital.

 

00:18:40:23 - 00:19:06:01

Kathy Sienko

Part of that is by releasing time to care, so using technology as an adjunct to enable clinicians to spend the maximum amount of time with patients. We have a very highly complex home healthcare service. There are things that we didn't used to do at home that we now do at home. We do quite a lot of telemedicine, not just in the Riyadh area or the Jeddah area, but across the whole of Saudi Arabia.

 

00:19:06:01 - 00:19:28:01

Kathy Sienko

We provide support to many other organizations as well. Even at the interface, the front, the entry point to the hospital, the way that we use AI agents as part of our customer service model, that has been part of how we've created a more seamless AV environment for patients. But our goal is always also down to some of the very simple things that I believe many people here will be doing.

 

00:19:28:07 - 00:19:48:03

Kathy Sienko

How do we keep an eye on safety every single day? Our huddles are a great way of doing that. And as the chief nurse, of course, nursing is a huge part of our organization. We are about 40% of nearly of the whole organization. Nurses are always thinking about what we could do differently to keep people out of hospitals. 

 

00:19:48:04 - 00:20:13:15

Kathy Sienko

So wound care is one of the areas that we're looking at matching clinician judgment with AI technology to see whether we can keep people at home, monitor their wounds at home without them needing to come into the hospital environment. The biggest thing that has happened for us recently is that there are many conditions that we use to send patients abroad for, people who needed CAR T-cell therapies.

 

00:20:13:15 - 00:20:38:10

Kathy Sienko

We've just manufactured our own CAR-T cells, have been able to treat, our first patient locally for what used to cost us millions of Riyals every year. And what that means is that we are then able to provide that for many more patients locally. So, I think this is just the start and that AI technology and the solutions we have will enable us to go much further in the future.

 

00:20:38:12 - 00:20:57:11

AJ Adel

Yeah. I can't wait to see some of the research that you're going to do on those patients. Nirav, moving to the Bajaj Group, which is in many industries and, and I'm sure you sit on multiple boards, and you get to see all the innovation going on in finance going on in transportation.

 

00:20:57:11 - 00:21:30:18

AJ Adel

Your sister organization, if I may say so. As you're building your new ecosystem, what are you seeing in other industries, like smart ideas, things that we can adopt in healthcare? And how do you see them playing a role in your future as a healthcare organization? 

 

Nirav Bajaj

So, thanks, AJ, for that. The way we're looking at certain things is when it comes to culture in India, a lot of the physicians are consulting physicians, which makes it - it's either you or me.

 

00:21:30:20 - 00:21:55:16

Nirav Bajaj

It's not you and me. And when I look back at sport, which I played very briefly in my life, it's a team sport. And how can you actually get physicians, nurses to work together for the common good, for the common goal of the patient who comes out the winner versus it's either your statistics or mine.

 

00:21:55:18 - 00:22:19:00

Nirav Bajaj

So that's when it comes to sports. I see our group's values for almost a century now has been transparency and trust. And that can only come with information and openness. So, I mean, if you see it, which happens in the U.S, I'm amazed whenever I fly in the US and I get notifications about delays on my mobile.

 

00:22:19:02 - 00:22:38:16

Nirav Bajaj

And I'm like, I wish that there was something as transparent when it comes to healthcare. And why can't we have possibly transparent, bill estimates and live bill tracking? In India, it's still very fee for service and out of pocket. So, we don't find out, how much we have to pay at the end of the day until the final bill shows up.

 

00:22:38:18 - 00:23:07:13

Nirav Bajaj

So instead, what can't I see along the way is what's my out-of-pocket expense? So, there's a lot of trust that doesn't exist in the healthcare ecosystem, which actually should be the most trusted industry. 

 

AJ Adel

Yeah. No, I think everybody agrees we would love to get to that point. And actually, you also engage with multiple other departments in the UK government, education, transportation and others.

 

00:23:07:15 - 00:23:29:12

AJ Adel

Are you seeing some of those innovations and are you trying to say the biggest flattery is copying. Are you trying to see what you can copy into healthcare ecosystem. 

 

Nicola Cottington

Yeah. Well in fact in the UK, we were lucky enough, a team of us from West Suffolk, to go to the Oracle Industry Lab in Readding.

 

00:23:29:14 - 00:23:45:00

Nicola Cottington

And I know the Oracle team were a little bit nervous about what they were going to show us there and thought, would we be able to translate this into healthcare? But one of the most exciting presentations when we were there was from the Red Bull Formula One racing team. And you might think, you know, what's the connection there?

 

00:23:45:05 - 00:24:16:10

Nicola Cottington

But really it was their use of data in real time. And it really made me think about how we could apply this in hospital and community services. So, what they're doing is they're using real time data the whole time while the car is going around the track, while it's in the pit stop, and looking at what can they tweak to improve performance but also running simulations constantly and using this single data layer to enable improvements all the time. 

 

00:24:16:15 - 00:24:42:22

Nicola Cottington

In the NHS and in our trust, we have so much data. And actually, we don't face, some of the barriers that other international, health services do in terms of sharing that data. But even within our organization, we have so many millions and millions of data points, and we're not using it in that way. So that's what really inspired me as to how can we use that both on a patient level and to spot what's going on for this patient right now?

 

00:24:43:00 - 00:25:07:18

Nicola Cottington

What's changing because we collect it all. But do we use it to inform their care now and their care in the future? But also, when you extrapolate that out to a whole emergency department. And so, what's coming in? How many patients need beds? How are we using all this to know what we're going to need to do in, you know, 12 hours' time? But also, when we're thinking about planning our new hospital, how could we run some simulations, you know?

 

00:25:07:18 - 00:25:29:08

Nicola Cottington

What if we change this? What impact would that have? If we added a ward here, added an operating theater here, what would the impact be? So that was what really inspired me. So, from thinking what's the connection with racing cars? There really are lots. There's lots of things that you can learn from other industries. 

 

AJ Adel

Well, everybody from Oracle here loves you for saying that.

 

00:25:29:13 - 00:25:48:10

AJ Adel

Russell, maybe we stay with you in one more question, and then we'll open it up for the panel here. A simple one with a complicated answer. 

 

Russell Harrison

There's no such thing as a simple question. You know that.

 

AJ Adel

 

No, no. Agreed, agreed. How do you see technology changing the game in healthcare? Let's just start there. What excites you about using AI in the ecosystem we're creating for the future?

 

00:25:48:10 - 00:26:14:15

Russell Harrison

I think it's the possibilities it's going to bring. It's the speed at which it will help, bring insights. I'm going to call it, rather than information to the fore for clinicians to treat our patients in different, better, faster ways. The stats about how quickly the evidence base is shifting is so quick.

 

00:26:14:15 - 00:26:31:14

Russell Harrison

You can probably leave university now, and it's out of date or leave med school and it'll be out of date. So, it's how we can enable our clinicians to give our patients the best care they can in that interaction, or over a series of interactions. And I think, you know, part of that is about how we do that better than we are at the moment.

 

00:26:31:16 - 00:26:47:22

Russell Harrison

I'm going to stay very grounded because we still use faxes in Australia to send information around. So, we digitize stuff, print it off, fax it, re digitize it. You know, we can't share things by email yet because it's illegal. So, I was kind of envious of what Nicola was saying about, you know, sharing stuff. So, it's nuts.

 

00:26:47:22 - 00:27:06:02

Russell Harrison

But that keeps us pretty grounded around where we can get the technology to get us to. So, it's going to be very pervasive, and it's going to be really kind of challenging.

 

00:27:06:04 - 00:27:25:11

Russell Harrison

But the challenge for me is our clinicians need to keep that critical thinking. They can't just rely on the tech. And I think we run the risk of making it too easy that they just become taskmasters, and they don't apply the judgment that will need them to continue to keep applying. And I think that's some of the challenge I see with the tech.

 

00:27:25:11 - 00:27:45:19

Russell Harrison

It's almost getting too good that if we're not careful, generations coming through, clinicians will get to the point where they're not thinking, they're not applying that critical judgment. They just believe the tech. Now, probably 99% of the time, it's right. But we really want our clinicians, as Kathy said, at the top of scope, doing what they've been trained to do, supported by tech.

 

00:27:45:21 - 00:28:05:16

Russell Harrison

And that's, I think, where we need just to be careful. But yeah, what we've seen this week is pretty impressive. I'm sure it will continue to accelerate. The pace of change now is huge. You know it's just continued to accelerate. So that's the exciting bit. And I think it's how do we keep pace with an industry that is often conservative and slow to adopt? We've got to change that very quickly.

 

00:28:05:18 - 00:28:24:03

AJ Adel

Yeah. A question for everybody and we'll start with you, Nicola. When we all retire and hopefully, we retire in the top of our game - we're going to look back and say we changed healthcare for generations to come.

 

00:28:24:03 - 00:28:44:10

AJ Adel

I think you hit on that a little bit, Russell. What's our role as a society here, as a healthcare society from your perspective? And we'll go down, down the list. What's the role that everybody in this room plays in creating the next generation of healthcare for our children and our children's children. 

 

00:28:44:10 - 00:29:11:22

Unknown

Nicola Cottington

I believe you can't be a leader in healthcare now without being a digital leader. But part of what we need to do are those leadership lessons that we all know, which is about genuinely listening to our clinical staff, our non-clinical staff and our patients about what are the problems that they have that we have a responsibility to, to try and solve for them.

 

00:29:12:00 - 00:29:38:02

Nicola Cottington

So, understanding how work really happens, not how we think it happens, that just because we've rolled out some tech, that everyone's using it and they're using it optimally. So really understand what's happening on the ground and then from that, creating a vision, a compelling vision and communicating that about how things could be. And from what I've heard the last couple of days, that is a really exciting vision.

 

00:29:38:07 - 00:30:03:21

Nicola Cottington

And the patient is at the center and it's patient powered and that's what people want, and that's what gets people fired up. 

 

AJ Adel

Beautiful. Kathy?

 

Kathy Sienko

So, I'm going to use a very sophisticated leadership term. I'm totally stoked about AGI. And I am so excited about AI agents, particularly for clinicians. I think it helps keep us on our why?

 

00:30:03:21 - 00:30:30:01

Kathy Sienko

Why are we all in healthcare? We are there to add value. We're there to solve and to deal with the issues that really matter to people. And I know that health is absolutely wealth. It's the tide that floats all boats. And if our goal is to have healthy communities, healthy societies, healthy individuals, then we really ought to do everything that keeps us focused on that space.

 

00:30:30:03 - 00:31:06:22

Kathy Sienko

And that means leaning into curiosity about what is possible. I think technology offers us the opportunity to democratize leadership to where the best decisions are not always made by the people at the top. In fact, that they're probably rarely made by the people at the top, But they're made in a more diffused way across organizations where we can innovate really quickly and where we can involve patients in a really meaningful way and not involve them by inviting them in, but partner with them to deliver healthcare in a way that is very different, and to receive and define healthcare in a way that's really different.

 

00:31:07:00 - 00:31:30:18

Kathy Sienko

So, I have no plans of retiring right now. I'm 57. I'm planning to live to 115. That's my plan. 

 

AJ Adel

Well, I think you touched on something that Nirav said, together, not separate. Absolutely, Nirav, Russel, final thoughts? 

 

Nirav Bajaj

So, I'm going to take a slightly tangential view on this one. 

 

AJ Adel

I knew it. 

 

00:31:30:20 - 00:31:59:15

Nirav Bajaj

Maybe I am not invited next year. But I think that culture is what really drives outcomes. The way the organization behaves and performs is the way that, patients will actually feel and recover. So, something that Tom said yesterday was quite interesting is how patients believe that AI was more compassionate and empathetic to the patients versus the physician. Well, I think that that's where the problem is, is we're people business.

 

00:31:59:15 - 00:32:24:23

Nirav Bajaj

We're not a patient business. So, we need to take care of our people who take care of the patients. And I think that that's where technology comes in and that's where AI comes in, is it builds in efficiency. And this is also probably a not-so-popular thing to say is about efficiency in healthcare. But efficiency and empathy are always in tension because empathy makes you inefficient, and efficiency makes you not empathetic.

 

00:32:25:01 - 00:32:49:01

Nirav Bajaj

But the reality is, if you can build in efficiency with technology at the back end to make your physicians, your nurses, and all of the staff who are at the hospital, at the clinics, actually spend more time and more care with the patients. I think that's what's going to drive, real outcomes. 

 

AJ Adel

Beautiful. Russell?

 

Russell Harrison

Dangerous going last because I got to say something profound, which is a worry. I should have let Nirav go last. 

 

00:32:49:01 - 00:33:12:22

Russell Harrison

But, I think, for me, the leadership thing that we need to do for the next generation is to promote better change management, to embrace the technology. And I think as a leader, I've got to encourage and keep promoting risk taking within whatever frameworks you have to comply. But actually, don't be afraid to push the envelope, to push the boundary, to take a risk calculated.

 

00:33:13:00 - 00:33:36:00

Russell Harrison

Probably better than just a wild one. But I think it's about keeping that ambition, as Nirav said, people are coming to care for people. They want to do that job. They've got a passion for that. That's what we're in healthcare for. It's about serving that patient. But if we lose the ability to take a risk, to do a challenge, to push the boundary we'll not improve care in the way that I think everybody wants to.

 

00:33:36:02 - 00:33:52:07

Russell Harrison

Tech will help that. But let's take some risks in and around the tech. 

 

AJ Adel

I think what I got out of this is nobody's retiring in this seat, and we're all going to live to 150. I'll do 140. I'm good with that. I want to thank everybody here. I want to I want to wish you all safe travels back home.

 

00:33:52:07 - 00:34:23:22

AJ Adel

And for our audience, thank you for being with us. And thank you for trusting us and continuing to partner with us in creating the future of healthcare. Thank you everybody. Appreciate it. 

 

Unknown

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/health and oracle.com/life Hyphen Sciences, or follow Oracle Health and Oracle Life Sciences on social media.

 

00:34:24:00 - 00:34:35:19

Unknown

Thank you for listening and join us again for the next insightful episode of Perspectives on Health and Tech.

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.

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Episode Transcript:

00:00:00

Nasim Afsar
You're listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data and technology to help improve health for everyone. 

Today on the podcast, we're discussing women and health equity. From personal and professional experience, how we've become familiar with the lack of resources and research on women's health and how AI and other technologies can help address some of these challenges.

00:00:35

Hi, I'm Dr. Nasim Afsar, chief health officer at Oracle Health. And joining me today on the podcast are three of my colleagues from around the world. I'll ask them to introduce themselves and give a brief overview of what they do.

Sarah Matt

Thanks, Nasim. I'm Dr. Sarah Matt. I'm a surgeon by training my fellowships and burns, but I've been in product development all over the world for my entire career. That's building our electronic medical records, new mobile applications, patient engagement solutions, you name it. First, I came in to drive our OCI, the cloud side of our business for health care and life sciences. And now, after our acquisition of Cerner, I focus on new product development. 

Nasim Afsar
Thank you. Esther? 

Esther Gathogo 
Hi, I'm Dr. Esther Gathogo, and I'm a pharmacist with 18 years' experience working across different sectors: community, hospital, academia and clinical research. And I currently work as a senior performance improvement leader in international based in UK. And I also focus on health equity and AI.

00:1:37

Nasim
Thank you, Esther. Christy?

Christy Dueck
Hi, everyone, I'm Dr. Christy Dueck. I'm the vice president and global head of our Learning Health Network and really have responsibilities around creating health system partnerships with life sciences industries to bring clinical research as an integrated component of clinical care. 

Nasim
Thank you, Christy. And my background is in internal medicine. I practiced as a hospitalist for over a decade in tertiary quaternary academic medical centers.

I've been in health care administration on the health care delivery side for over sixteen years in roles, in quality roles, in health management, contracting and health care operations. My team is focused on how do we ensure that across the globe we have healthy people, healthy workforce and healthy businesses. Driving the best of products and services to ensure that we're improving the health of the world.

So thrilled to be here and thank you all for joining me today as we talk about women and health equity. 

00:02:47

To start us off, I want to talk about the moment that you all realize that there is a wide gap in women's care and that could be either personally and professionally. 

Nasim 
So, to kick us off all kind of share a story from my background. This really kind of hit me a number of years ago when I had the privilege of taking care of a 48-year-old woman with end-stage metastatic colon cancer during her final hospitalization. I learned during this hospitalization that leading up to her terminal diagnosis, for about a year, she had seen a number of providers with her symptoms.

Initially started off with fatigue. She then had some abdominal pains, some nausea, and this was continually attributed to stress, irritable bowel syndrome. And during those 12 months, she was really never provided the appropriate diagnostic interventions, like a colonoscopy, until it was too late. 

I also learned during that time that she was a phenomenally dedicated teacher. She was a caring mother. She was a spouse, a child, a sister, an incredible friend to many. It was absolutely heartbreaking to see that her voice was not heard as she didn't receive standard of care that really could have been lifesaving. And I wish I could say that this was a rare case. But cases like this happen every single day in the U.S. and across the globe.

00:04:22

Christy, I'm wondering if you can share with us when this really became real for you. 

Christy
Sure. A little bit different story for me, and mine's actually personal. So, when I was studying pre-med, I was an intercollegiate athlete in rowing with aspirations of competing at the national and elite level. And like so many female athletes' experience, I really got caught up in the cycle of being asked to lose a significant amount of weight by my coaches, because rowing, like other sports, has weight classifications.

So over the course of a summer, I dutifully lost 35 pounds and returned back in the fall at under 130 pounds, which is a light weight. And in about three months I had a full osteoporotic hip fracture at the age of 20. And it was really a peak milestone for me. I was in my junior year. I was pre-med at the time.

00:05:22

I was never given, obviously, any guidance around the impact that that weight loss would have on my health, my endocrine system. And so that was really a milestone of it ended my rowing career, unfortunately. But it was really a driver for my career. I went on and got my Ph.D. in reproductive endocrinology and did a whole lot of research around the female-athlete triad since I was sort of the poster child for it at that time.

00:05:50

Nasim 
What a challenging personal experience to go through. Christy, thank you so much for sharing that, Sarah. 

00:05:58

Sarah
So I think, you know, as I went through my medical training, you kind of see things, you hear things, if things don't seem quite right a lot of times. I think where it really hit me is when I started having my own children.

So, I have four kids, and my first, I was still doing surgery at the time. And when I think back to that time, there were so many assumptions made about what I, as a professional, might already know about women's health or might know about my own body, and that I didn't. And when I would ask caregivers, they would either be like, "Oh, well, you know, it's this or it's that."

And I think that having come from the medical field and having a baseline of information already, I still didn't have the answers I needed. And I was relying on my grandma or my mother or my sister or friends to ask advice when I couldn't get what I needed out of the medical system. And as a medical professional, I needed information like, "Hey, if I'm going to go into a vascular procedure, do I need to wear lead?"

00:06:57

"Hey, is this chemical okay for me? What if I get exposed to that?" And yes, sometimes there was a paper that I could Google and sometimes I could ask my doctor, but sometimes there just wasn't. And there wasn't the right people for me to ask within the medical community or otherwise. So I can really see how people just struggle, because I had, theoretically, all the resources I could possibly want available to me, and I still couldn't get the answers that I wanted.

00:07:27

Nasim
Thank you for sharing that, Sarah. It really brings out the part of the heart of the matter, which is even when you have resources and knowledge, it can be so incredibly challenging. And so many women across the globe don't have the resources and the knowledge. Esther? 

00:07:46

Esther
I'm just going to take us back to the early years of when you're probably a teenager and you had the reproductive health conversation. And I was in boarding school and we came back after having been given sanitary towels and shown tampons and everything else.

And I think at that point the main focus was on the menstrual cycle and what's normal. But no one really talked about how bad it can be, I think for most. And so I think what became very clear is when girls, you know, because that's the stage when the menstrual cycle is being regular, more regular, and you started to see serious, serious problems.

00:08:33

You know, we had one girl who had to be taken by ambulance and started on a drip for menstrual pain, you know, and it's something that hadn't obviously seen before. And then as we got older, the conversations where I've had friends who've had a hysterectomy before 40 for benign conditions. And when you listen as a group, particularly around the problems that people face with the menstrual cycle, you realize that there's not a lot of treatment options.

And this is after many years of many women coming in to the medical center and recognizing that 10, 15, 20 years down the line, we're still using hormonal treatments as the main treatment for most of the conditions. 

And I think when you listen to how, you know, it's impacting the mental health, you know, the life and social life and just their well-being, then you end up realizing that over time, more needs to be done with this. You know, because I think the medical community has somehow become just complacent because they have benign conditions and they can see that it's, you know, in terms of self-management or whatever it is that women do.

00:10:06

But I think thinking about now, especially as we are working women and, you know, how stress affects your system, it's something that I think and just thinking about needing more options. And like even getting down to understanding the basic understanding of why the disease happens, you know, some of those questions are still, you know, they're not there. So that's why.

00:10:35

Nasim
Thank you for that, Esther. I think you highlight the challenges of managing something that is as basic as it gets and it's biologic, and how much work and understanding still needs to happen for some of the most basic and biologic processes in women. So I really appreciate you sharing that. 

00:10:56

So, we know that a lot goes into these gaps of care from lack of understanding or honestly acknowledgment of biases in vulnerable populations to lack of medical and pharmaceutical research considering women's health, I think you all touched on different sides of this. So let's focus on representation of women and women of color in research. What has been done to address this gap in research and data? Esther, I'm going to ask you to kick us off. 

00:11:30

Esther
Yeah, and I was reading a bit around this and just throwing out some figures that, you know, women are representative of 22% of clinical trial research.

And for women of color, it's been reported even as low as 2%. It makes you think about the information in terms of the clinical research, whether it's truly representative of the diversity of women, you know, across even the globe, if I want to say it that way. And we know that if there's such a low representation of the of women in clinical trials, it means that products are being approved without, you know, the representation of these women.

And it means that the real-world evidence then becomes really important. Which is where I think if we are then using these products, we have to understand that the female body and the diversity of all of us in terms of the genetic background as well—and that diversity means that they might respond differently to the approved medicines—is also thinking about like how to recruit and making it a lot simpler for women in terms of understanding the products.

00:12:51

Because one of the biggest things would be how does this product affect my body? Most of the time people are concerned about fertility, you know, and a lot has been done over the years to try and just put women's minds at ease. But it is difficult. 

And this is where I find that the electronic health record and thinking about not just about that the information is within the record, but are you collecting information in the clinical care of women and representing it in that way and within if you're doing clinical observation studies, because if you've got a product and you're not, for example, collecting information on the impact on the menstrual cycle, but you're getting lots of reports from women saying they've had a few missed menstrual cycles and they don't understand why it could have been the product that they're taking. But if this information is not being captured, then it's not within the system, which means that you start you still can't glean the insights that you need from the electronic health care records.

00:14:03

So I feel that not only around and when you look at internationals looking at the numbers in terms of the proportion of women who are conducting clinical research as well, and that's quite low. So it can also then make you think about in the end, when are designing the clinical trials, is someone speaking up for the diversity of women to include them in the clinical trials or in the trial design?

Because then you are collecting the information that will be useful as well for women when it comes to evaluating whether or not they should take a product or they should be recruited into a trial. 

00:14:51

Nasim 
So there's a real multi multifaceted problem, right? It needs to really be tackled from multiple, multiple angles as you highlighted. So, Christy, Esther highlighted how low representation of women and minorities as has carried out in clinical research. What are we going to do to fix that?

00:15:11

Christy 
Oh, that's a big question, but I think, you know, we got to we got to start with working with what we have in the most effective way. And so, you know, from my angle of the world, I'm not a practicing clinician, but I've been engaged in clinical research my whole career.

And coming from Cerner, we had this realization of, oh my gosh, we're literally sitting on 40 years of digitized health care data. How do we turn that as a giant lever to help address some of these broad stroke issues, like women and access to clinical research?

And so in my world, one of the things that we did was create a partnership with health systems and an opportunity for them to share their data with other health systems so that we could create a searchable dataset, a real world data set that we could then work in partnership with health systems to bring clinical studies that address issues in women's health to the point of everyday health care, and use that data as the accelerant to get very prescriptive in finding women that are a match for the specific study criteria or enabling care teams to engage directly with their patient populations that may be a fit for a new, innovative trial in a rural community that would never have had that opportunity before. So right now we're sitting at this critical point in health care where we know we've got a whole bunch of data.

00:16:51

That's our quality problem. We've got more data than we know how to use. And to Esther's point, it's now making that data a lever we can pull to accelerate clinical research, to focus on the specialty groups where we've seen disparities in care given up until this point in time. 

00:17:11
Nasim
Agreed. Agreed. So, you know, we've talked a couple of times around the role of technology in helping address disparities.

I want to focus in on the role of AI in health care delivery. What's the potential and what are the downsides? 

00:17:30

Sarah
So, you know, when we think about AI/ML it's been the buzzword for how many years now? And I think during COVID, everyone recognized that we have to do things differently now than we did in the past.

And so everyone's heard about ChatGPT. It's been a huge buzz. Everyone wants to talk about AI/ML, but a lot of health care organizations, a lot of ministries of health, have been slow rolling in how they deal with AI/ML over the last couple of years. A lot of that has to do with trust and why would we be concerned about that for the same reasons that health care in general has had problems for decades and decades and decades.

00:18:04
So that means whether it's structured data coming from an electronic medical record, straight from a clinical trial database, wherever that data is coming from it, we have to make sure we're comparing apples to apples. And every single algorithm, every AI model that we build out, has to be trained.

So, when we think about women's health and how we can improve women's health, ultimately, there's going to be models that are trained on data that doesn't include women. Well, how is that going to impact us? 

If you think about all the different ways we treat people today, whether it's in nephrology and kidney health and the way African-Americans have been treated in the past, in terms of those algorithms, whether it's X, Y or Z, we have so many clinical rules that we use today that have their own inherent biases based on medical data from the past.

00:18:54

So if we're going to build out new algorithms, we have to make sure that we're training it properly. So things to think about for people developing these algos is: who is your set of patients that you're going to bring into this model? Are women included? Are people of color included? What other kinds of people should be included in this algorithm's data set to make it a great model?

When we think about women's health in general, using more automation, using more AI/ML, could it help women in their ability to get care for themselves? It absolutely could. When we think about the nursing shortages all over the world, when we think about how hard it is to make a doctor's appointment on a Monday, when you have a bunch of kids, when you have a job, when you think about how much time a provider is actually going to take with you … how can we automate things for the patient?

00:19:48

How can we automate things for the provider? How can we provide that small town doctor feeling in 15 minutes? How can we provide that care and engagement with less? Because right now I think what we're finding is that the system's stressed, all the people are stressed, the patients are stressed. Everyone needs a break and we can't do more with less. We're going to have to do things differently. 

00:20:18

Christy 
I love that. I'm just going to jump in right now and do a high-five to you on that one, because I think, right, fundamentally—and, Nasim, you and I've talked about this before as well is—at the end of the day, we have to change our behavior around health and care, regardless of what side of it you're on, whether you're a provider of it or a receiver of it.

And that behavior change is what's going to drive our ability to be able to actually leverage and receive the benefits of all the cool stuff, Sarah, you just talked about. But if we don't change the behavior around health care as the starting point, it doesn't matter what great tools we develop if people don't use them. And so in my world, you know, we're trying to engage critical-access hospitals who have never, ever participated in a clinical research study before.

00:21:14

And the first thought and the first line of defense is, "I don't know how to do that. We've never done that. No." And really, it's creating that opening of, "We're here to partner with you. We've got all of the tools and technology in place to enable you to do it." And at the end of the day, we want to make, just like you said, those 15 minutes with the community members that you serve more impactful and with the option to bring more innovative things to your community than ever before.

And on the patient side, or being a community member, you know, I love all the powerful stories that I get to hear of people who are busy, women who are really busy, and now they look at participating in a clinical trial as even a control patient, as a way to give back, as a way to serve. And most of those stories end with an, "Oh my gosh, I thought I was a control patient, and I actually got diagnosed as a result of my participation in that study because I haven't done anything in my health care over the last three years with COVID" because of all the reasons we all just talked about.

00:22:22

Nasim
I think you all highlighted how technology can really be used to facilitate receiving care, getting care, getting better care, facilitating your care at the time that we need. And there are barriers that we have to overcome. And I think that's kind of Christy, your point about that changing relationship. 

Esther, you were touching on this. I think those are the elements that we have that we have to work through as a society to be able to move things forward. 

00:22:56

Well, thank you all for joining us for this thought-provoking conversation about women and health equity. I want to thank our panelists Christy Dueck, Sarah Matt and Esther Gathogo.

Great conversation around the role of technology and how can we address some of these shortcomings and limitations that we have for women to receive better care. But lots of areas identified where we really need to work together in partnership to address this as we move forward. Looking forward to ongoing dialog around this, and more importantly, action around how we can impact better health for women across the globe. Thank you.

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

Summary

It's essential to prioritize cybersecurity, particularly for healthcare organizations that handle sensitive patient information. With so much at stake, it's critical to recognize the importance of cybersecurity and take proactive measures to prevent potential breaches. In a recent discussion, two experts from Oracle emphasized the significance of areas such as ransomware resiliency, cyber-recovery, and other crucial aspects of cybersecurity.  

 

Featuring

• 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.

Mental health remains a significant area of concern in healthcare, especially after the pandemic. Universal screening tools, such as suicide risk assessment, have become a vital resource. One of the best ways to normalize mental health screening is by integrating it into your clinical electronic health record (EHR) workflow. However, with the influx in risk assessments, is your staff confident and prepared to handle the needs that arise? And does your organization have the infrastructure required to support those needs?

While telehealth has alleviated part of the burden for providers, it has also exposed many ways technology can create barriers to care, especially for communities who are already at a disproportionate risk for suicide and addiction. So, how can we better coordinate care across the illness-wellness continuum? Join Danny Gladden and Dr. Sarah Matt as they discuss the progress and opportunities to support mental health and improve suicide prevention.

Guests:

Danny Gladden, director of behavioral health and social care, Oracle Health

Dr. Sarah Matt, vice president of product strategy, Oracle Health

Hear them talk about:

• Education and training for physicians regarding suicide assessment and prevention treatment (2:00)
• Suicide screening assessments and lack of staff resourcing and infrastructure to meet those needs (4:15)
• Crisis intervention training for first responders and the increased availability of mental health first aid (11:15)
• Telehealth doesn't solve access to care issues—there's still a gap in equity and barriers to care (13:00)
• Benefits of behavioral health data collected on digital record (15:15)
• Moving toward a consumer-focused patient experience (17:20)
• Suicide prevention resources (19:18)

Learn more about Oracle Inpatient and Outpatient Behavioral Health solutions

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Episode Transcript:

00;00;00;00 - 00;00;30;09

Danny Gladden:

You're listening to Perspectives on Health and Tech, a podcast by Oracle, where we have conversations on creating a connected healthcare world where everyone thrives. Hi there. I'm Danny Gladden, clinical social worker, director of behavioral health and social care here for Oracle. Dr. Matt, so glad you are here.

Dr. Sarah Matt:

Thank you, Danny. I'm so excited. You know, when it comes to suicide prevention, I think there's so many problems that we could talk about, but I think there's also solutions and things we can do next.

 

00;00;30;16 - 00;01;06;28

Danny:

So I'm excited that we're talking about this topic today. Yeah. And, you know, I think we've made some great progress. And I say we as the collective, we myself, I'm a clinical social worker that practices in mental health services. I've actually ran one of the National Suicide prevention lifelines, but suicide prevention takes all of us. And so, you know, I'm actually just curious, you know, you're a physician—think about your preparation into sort of medical school and residency.

 

00;01;06;28 - 00;01;26;15

And you know what does what did your preparation look like as a physician assessing for and treating suicide risk?

Sarah:

So I went to med school a long time ago, I will say, But when it comes to training, it was very traditional. So four years of med school. And then I did my residency in general surgery and my fellowship in Burns.

 

00;01;26;17 - 00;01;56;05

So I'd say that when you think about structured learning for mental illness, it was pretty scared. Most of it was around inpatient mental health services. So that's the rotations that we did in medical school. Now there was the small bits and pieces you may have gotten on your primary care rotation, but it really wasn't a focus. Now today are unclear how the clinical rotations are going and how the medical schools have changed their training.

 

00;01;56;12 - 00;02;19;17

But I would say that for the generations of doctors that are in my age category, it definitely wasn't something that was highly stressed.

Danny:

Yeah, you know, in the last couple of years, I get invited from time to time to come in and speak to first or second year medical students, particularly on the subject of suicide assessment, suicide prevention, collaborative safety planning.

 

00;02;19;17 - 00;02;58;19

And I, I think that structurally we've come a long way in normalizing the assessment of suicide risk. We have built it into much of our clinical workflows. The Joint Commission has guidance on how on how we assess for suicide risk. But I think even maybe where there is some competence that's been gained, there's still a gap in competence, particularly because of our own fears around, oh, if I ask someone about their suicide risk, what will I do with the information they provide me?

 

00;02;58;19 - 00;03;28;02

And particularly I think about our community access hospitals it at 2 a.m. who are sort of dealing with folks with limited resources, limited specialty consultations and whatnot. And so we celebrate universal screening tools such as the Columbia Suicide severity rating scale or many other really great evidence based, validated tools. But I know that we have a long, a long way to go.

 

00;03;28;02 - 00;03;54;21

And so as we think about September Suicide Prevention Awareness Month, we think about the physicians and the nurses and those and quality and compliance who are working to manage risk within a within a hospital health system. What are you seeing best practices from a technology perspective in how folks are leveraging technology to assess for and prevent suicide?

 

00;03;54;24 - 00;04;18;18

Sarah:

So it's hard to say best practices because I think we can still do a lot better. A lot of times everyone at the administrative level of a hospital system recognizes the importance from a regulatory perspective, from a compliance perspective for universal screening for suicide. And a lot of times this kind of shows up as an extra forum for the nursing staff on intake and things like that.

 

00;04;18;20 - 00;04;37;14

I think some of the things that are missing are the why and the importance. And so in a system where nurses, doctors and all the rest of the staff are highly strained, sometimes it's difficult to do another form. The other thing I had mentioned is that a lot of times this burden is put again on medical assistance and nurses.

 

00;04;37;21 - 00;05;02;21

The providers rarely do these screens themselves, and I think that oftentimes they might not know exactly what the screening is or how useful it can be. So for their patients, where they may have a potential and or a diagnosis to have some sort of depression, anxiety, etc., there's things that they can use. There's tools that are available and they may not have all of those at their disposal.

 

00;05;02;23 - 00;05;57;11

Danny:

Yeah, again, back to the community access hospital or the Alaska village that's using a health aide, for example. I think about that 2:00 in the morning assessment that the sort of mandatory requirement in policy to assess for suicide risk and the patient sort of reporting some level of suicidal thoughts and the provider, the nurse, the health aide in Nome, Alaska, wanting desiring to do what's best to keep the patient safe, but also have limited resources to be able to, you know, get that get that individual true specialty care.

 

00;05;57;13 - 00;06;47;01

And so, you know, celebrate universal screening. But also worry about actual the what happens on the other side of a positive screening. Is it possible that we are unintentionally over hospitalizing folks with the best of intentions or over incarcerating folks with the best of intentions to keep to keep patients safe and to keep the community safe because of lack of available responsiveness from trained mental health professionals who can a dig deeper into assess, assessing and understanding is there a true lethality risk or is this someone who has what we might call morbid ideation?

 

00;06;47;01 - 00;07;18;00

You know, if I didn't wake up tomorrow, that would be okay. But no, I'm not actually going to hurt myself. And then also the ability to build collaborative safety plans. Right. We don't get to draw blood or run an X-ray to know someone's risk, right? We get to ask a bunch of really intrusive questions and then the intervention is not is not often, particularly for suicide risk, medication in real time or a cast or another medical device.

 

00;07;18;02 - 00;07;47;26

It is a really intense creation of a collaborative safety plan that's a usable tool for the for the patient to leave the hospital to help them recognize their own triggers and to help them utilize their own resources, their own social network, for example, to mitigate that risk. And so I celebrate universal screening and I worry about the infrastructure that's behind it.

 

00;07;47;26 - 00;08;21;23

And let's just say, Dr. Matt, the you know, someone does have a risk of suicide or other psychiatric disorders that need to be treated. We have an infrastructure that doesn't have enough available beds and that folks often get housed in emergency departments, get housed in municipal jail cells. At times they get housed in med surge out of a desire to keep them safe.

 

00;08;21;23 - 00;08;42;24

Sarah:

I'm curious what thoughts you have kind of on the current state of mental health delivery. So I think that, you know, as we go past universal screening, we've just screened all these people, just like you mentioned. Now, what is the problem? And I think you're right. In a lot of environments, everything from primary care to pre-hospital to inpatient.

 

00;08;42;26 - 00;09;06;07

The next step is the hard part is the hard part for the patient who may need extensive therapeutics as well as medication. But from a provider perspective, what do you do next? If you are in a small rural hospital, you may not have access to a psychiatrist in the middle of the night. It might be that that personally comes every couple of days.

 

00;09;06;07 - 00;09;24;12

It might be that you do a televisit in the morning. What do you do for that patient in the meantime? And you may not have a lot of options. So I think you're stuck in a lot of ways. If you're in a primary care environment and you have a patient that has immediate needs, what are you going to do?

 

00;09;24;12 - 00;09;49;27

How do you help them? You have to send them to the hospital because there's nothing else you can do. It's outside of your scope. And then if you're on the streets, you know, from a pre-hospital perspective, having been an EMT in the past and still as a firefighter now in a volunteer situation, when people are on the streets having a crisis, it can be really hard for civilians to say this person is dangerous or this person is having a mental health crisis.

 

00;09;49;29 - 00;10;14;16

And I think that what we found is there's just not the resources to come and assist those folks. We have firefighters, EMTs and police officers. That's basically we have on the streets. We don't have an army of social workers like yourself, Danny, that I can deploy to help people who really need it. Now, I know there are some cities and some municipality that are doing more in that area, but we could do a ton more.

 

00;10;14;16 - 00;10;49;28

It's really hard, though. So what I'd say is I think that universal screening or again, providers, nurses all doing the best they can, they're seen issues, but they don't have a lot of options for the next step. And I think that's problematic.

 

Danny:

Yeah, for sure. You know, in many cities across the country, law enforcement, paramedics and EMTs, firefighters are are getting some really great training crisis intervention, training to help be able to sort of manage a mental health crisis and in real time.

 

00;10;50;00 - 00;11;17;12

But the scale of all of us need some variation of mental health first aid, which is available for free in most communities to be able to, you know, for getting CPR training and first aid training. Mental health first aid training is also an essential part of being able to being able to work with folks in real time and in our communities.

 

00;11;17;15 - 00;11;46;28

You mentioned telehealth visits, and I was, you know, drawing on my extensive experience in Alaska. And you know, we have sort of a paradigm shift through COVID by which much of behavioral health services that occurred within the four walls of a clinic or a hospital have now transitioned to the home. And that's so exciting. It was it was it was a big shift.

 

00;11;47;00 - 00;12;19;24

But I also think about folks living with severe mental illness, often who share other social vulnerabilities, such as such as housing insecurity, such as technology insecurity. And I'm wondering if you can talk a little bit about tech equity and sort of the division between the advancements in technology and the delivery of care and those who are also left behind?

 

00;12;19;26 - 00;12;43;28

Sarah:

Absolutely. So I think it's interesting, Alaska is a really good example of where telehealth has been immense in the ability to reach patients. But I think we take for granted that you can have, I'd say, health care deserts in a big city, health care deserts in the middle of the country, health care deserts, not just in a third world country per se, but right here in places that we go every day.

 

00;12;44;01 - 00;13;12;11

And a lot of that has to do with socioeconomic issues. But what does that mean from an access perspective? Do our patients have Internet? Do our patients have cell phones? Do they have smartphones? Do they have enough data on their data plan to utilize that smartphone for a television as an example? So when it comes to mental health, there's a whole slew of new commercial offerings for tele psychiatry where they even will prescribe medication.

 

00;13;12;11 - 00;13;33;28

And that's a really interesting option, especially when we think about the stigma around mental health services. And so getting more people to be served is wonderful, but it may be disproportionately serving certain populations. The populations that their only Internet is at the library are not going to be able to have a televisit in the middle of a public place.

 

00;13;34;01 - 00;13;58;24

Those folks that have a data plan that maybe isn't so large, are they really going to use our data plan to have a televisit? Hey, that's a tough one. And the other piece is really around different kinds of people. It's even harder for children and teens to get the services that they need because pediatric psychiatrists are far and few between at baseline.

 

00;13;58;27 - 00;14;28;07

And again, a lot of people, especially minors, but in teenagers need help. They need lots of different things, but they're not on their own insurance. They don't have the ability to do a lot of things someone who's not a minor can actually do. So I think it makes it even more difficult.

 

Danny:

Yeah, And I'm thinking on the other side of technology, I don't I don't know if you know this data point, but in the United States, only about 30% of behavioral health providers are using some sort of a digital record.

 

00;14;28;07 - 00;15;16;26

And so not only are we sort of pre info sharing and pre and are off, we there's really no consistent way in which mental health data is collected and shared. And so it means each time someone is having a mental health crisis or needs to present for a new mental health provider, they have to start from scratch and retell their entire story, answering intrusive questions from a provider who is a stranger to them. And I'm super excited about, you know, from a policy perspective, I think I think there's some there's some great work happening in the United States to sort of encourage and push providers towards a digital record.

 

00;15;16;26 - 00;15;54;00

And I'm sitting in London right now where the NHS has a mandated that mental health providers move that are part of the mental health trust move to use have a digital record. And I think the more we can sort of use what are now traditional technology tools in the delivery of mental health service says the better we'll be able to paint a true picture of a whole person as far as care is delivered and folk can be shared.

 

00;15;54;03 - 00;16;32;00

One treatment plan that covers hypertension and diabetes and depression and anxiety. And so I certainly am excited about the direction we're going. I'm wondering, as you know, we probably have a couple of minutes left here. If you see anything on the horizon that that's exciting from you or from you from a technology perspective.

 

Sarah:

So I think now, especially in a post-COVID world, consumers are demanding more and ultimately it means there's more solutions for folks to obtain mental health services, whether psychiatrist, counselors, you name it, in the palm of their hand.

 

00;16;32;03 - 00;16;56;16

Now, again, we mentioned there might be some equity issues there for sure, but at the same time, there's so many folks who may have access to a cell phone as an example that could really use that assistance. So I think that the advent of a more consumer focused, patient centered experience is helping there. And with these new digital consumer grade solutions, it means we're digitizing behavioral health, even if it's from the intake part.

 

00;16;56;16 - 00;17;28;07

For a patient that's half the battle. As a primary care provider now in chronic care management, it's really hard for me to have a new patient come in who might be an immigrant who does not have documentation, to have someone who lost their insurance. All these different problems at the charity clinic where I work to help them in their journey, because if I had documentation of what their issues had been and how they'd been treating the past, my scope of practice includes depression, so I could definitely help them with some therapy and some medications.

 

00;17;28;10 - 00;17;54;01

But my solo practice doesn't include things like bipolar as an example, so how can I get them to the right people? But if it's not documented, that's really difficult for primary care doctors in particular.

 

Danny:

Yeah, such a great point. No doubt we are moving into what I would call the techno, you know, the technology age for mental health and social care service delivery.

 

00;17;54;01 - 00;18;27;18

And that's, you know, from a from a consumer perspective and the quality of applications that are making their way into the market. But it's also from available free available community resources. And I think maybe we can just close with this for our US listeners, there's available 24/7, the National Suicide Lifeline in the last 12 months. It's gone from a gone from a 1-800 to a three-digit number that that all you have to do is remember that number is 988.

 

00;18;27;20 - 00;18;55;14

It's available for you in your community today. It's available 24/7/365. It's available for you to be anonymous if you so choose. It's also available for you if there's someone that you care about and you're trying to figure out how best to help this person out; the folks who answered the 988 number are happy to sort of talk through with you how best to help someone that you care about get connected to resources.

 

00;18;55;16 - 00;19;18;05

Unknown

When you dial 988, our veterans have a have a special have a special option to talk to someone who is understanding and committed to veterans-specific topics. And there's also Spanish speaking. There's also a Spanish-speaking prompt or a prompt for our LGBTQ+ listeners. And that's just in the United States. I know we have listeners from all over the world.

 

00;19;18;07 - 00;20;05;27

Most countries have some sort of a national Suicide Lifeline phone number. So September Suicide Prevention Month couldn't be more lucky to spend some time with you. Dr. Matt, thank you so much for sharing your expertise and experience with our listeners.

Sarah:

Absolutely. Thanks so much for having me.

Outro:

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

As part of the No Surprises Act, healthcare systems must now provide comprehensive good-faith estimates for the cost of care—both from their own organization (relatively easy) and from outside providers (much harder). Listen to industry leaders Seth Katz, University Health, and Josh Mast, Oracle Health, discuss with Jodi Busch, Oracle Health, the impacts of good-faith estimates on health organizations and how to use this phase as an opportunity to streamline workflows and better prepare your teams for the next iteration of the No Surprises Act.

Featuring: 

Seth Katz, Vice President of HIM and Revenue Cycle, Finance, University Health  

Josh Mast, Director and Product Regulatory Strategist, Oracle Health  

Jodi Busch, Senior Director of Financial Alignment Organization, Oracle Health  

Hear them discuss: 

• An overview of this year's iteration of the No Surprises Act (1:16) 

• How have these changes impacted safety net hospitals/organizations? (3:36) 

• How are schedulers at hospitals/organizations handling the increased duties of working good-faith estimates? (5:05) 

• Was it difficult to gain internal buy-in from your staff for these changes? (6:57) 

• Have you had any issues sending the good-faith estimates back to patients in the allotted time? (9:39) 

• Are there penalties for non-compliance? (10:59) 

• How does the enforcement discretion potentially impact the overall process? (13:29) 

• Where are you at in terms of combining providers inside and outside of the organization? (15:06) 

• What has been the response back from patients regarding good-faith estimates? (16:10) 

• What's coming next? (17:29) 

Notable quotes: 

"We have to remember that we work in healthcare to help take care of people and make them better and that the No Surprises Act, price transparency, information blocking are good things for the patients." – Seth Katz 

"At the end of the day, this is about trying to get patients and consumers information prior to receiving care so that they are better informed." – Josh Mast 

In the US, big leaps have been made toward industry-wide interoperability in recent years. From establishing a standard set of health data that must be exchanged, to broadening the scope of the ban on information blocking—recent regulations have driven positive advancements to simplify health data sharing across vendors and venues of care.   On top of all that, the Office of the National Coordinator and The Sequoia Project, the Recognized Coordinating Entity for the Trusted Exchange Framework and Common Agreement (TEFCA) established under the 21st Century Cures Act, announced the first applications accepted for Qualified Health Information Networks (QHINs) under the TEFCA. That short list included CommonWell Health Alliance, of which Cerner,  now Oracle Health, was a founding member nearly a decade ago. 

This is a leap forward in achieving our vision for interoperability. Our shared goal with CommonWell joining TEFCA is to build a nationwide health information exchange,  leveraging a collaborative trade organization, that will help give patients access to their healthcare data regardless of where they receive care.    Listen in as we talk about the exciting progress toward nationwide interoperability and how it will benefit patients and providers.   Featuring: Paul Wilder, Executive Director, CommonWell Health Alliance Sam Lambson, Vice President of Interoperability, Oracle Health   Hear them discuss: • TEFCA and what it means for advancing interoperability (2:10)  • Benefits of better information exchange for providers and patients (3:49) • How a record-location service is more accurate, efficient and secure than geo-locating like many systems use today (6:45) • When does TEFCA start affecting patients and providers at the point of care? (13:04) •How does TEFCA impact gaps between care, translating care, and settings of care, like telehealth? How does it affect patient engagement and involvement? (17:00) • Ways to learn more and ask questions (19:20)    Notable quotes:  "Me having my data is not just a toy. It's not just I want the image because it's interesting … I want the report. It's that I want to manage my health, or that of my children, or my parents in a better way—which I think in the end is really going to benefit the provider." - Paul Wilder 
"And think of mental health—it gets even more robust as we're expanding services a lot right now. If we don't do it efficiently, it's going to get very expensive. And getting past all those administrative flows to get to the care you need at the level the person can do it in front of you—as opposed to what the data is allowing you to do—is, I think, really important." - Paul Wilder   Resources

• TEFCA: A leap toward achieving nationwide interoperability
• Sequoia Project
• CommonWell Health Alliance Reacts to QHIN Application Approval