Welcome to The Healthcare Cure podcast, a podcast dedicated to the bold mission of fixing healthcare. Now, here’s your host, healthcare futurist, best selling author and adjunct professor Nick Webb.

Welcome to another episode of The Healthcare Cure podcast. Today I’m with Dr. Ray Power, and with Dr. Miari. What I love about these two guys is they’re both friends and also colleagues. I get to work with them every day, which is a really exciting thing. I learned so much all the time. And today we’re going to try to debunk some of the myths associated with this idea of digital health. And one of my biggest concerns that I find is that the overwhelming majority of the legacy mindset, that is individuals who have been in healthcare for a long time, they see digital and they see technology oftentimes as subtractive. Rather than additive they see that it sterilizes the personal human connection between a patient and between data. And and I think that that’s unfortunate, although that can certainly happen. It’s not necessarily going to happen if we architect the right strategies and use technology in a way that is both beneficial for the patient and the caregiver. So I’d like to start with you, Dr. Miari. If you could also maybe just do a quick background, and then let’s get your opinion on why you believe that technology is an additive thing and not a subtractive one.

Yes, Nick. I’m very glad to be part of this and it is a great joy to share. My background has been in the healthcare for the past 20 years. My main interest has been in medical education as well as healthcare technology and AI has been a fascinating field for me personally, and we all know that recently, it is not a day that goes by without people launching or talking about AI solutions. But most importantly, AI has really taken over in healthcare. And granted, we are probably three to five years away before we realize all the potentials of AI. However, as we speak, there are so many low hanging fruits that AI has already proven to be extremely valuable, and has actually transformed our healthcare in many ways. And to your comment, Nick, regarding the fact that really technology is not really meant to replace the doctor. It’s meant to supplement the doctors that there will be never any replacement for the personal touch to medicine. And so technology then comes into place as a means to enhance the experience, not to change it in a way that it’s all automated and all mechanical. So I think that has to be really stated from the get go to understand the fact that AI is going to be making a huge impact on healthcare. At the same time, we need to understand that AI is going to be also enhancing the healthcare touch experience and not the other way around. I hope that makes sense, Nick?

Yeah, absolutely. I think that’s exactly right. Ray, do you feel as a primary care physician, do you feel that the general census is from caregivers Now I know that you get the benefit of working with a lot of future thinking caregivers, but in general, do you feel like there’s a real resistance to the adoption of high technology and especially in the area of diagnostics.

Yes, I do, in general terms because we don’t have the exposure in our training to that type of modality as a really valuable adjunct or enabler for us, as you just described Miari to improve the healthcare touch, or as I like to call it perpetual touch I to give our listeners a little bit of background, a Irish based primary care physician, I’m delighted to be collaborating closely with the Center for Innovation at Western U and visited Miari and his colleagues in the center of which you’re the head Nick and I’m really impressed with a number of things that you’re doing. With regards to, I guess, dispelling that anxiety that the physicians for the future will have for technology, they’re, they’re embedded with the millennials live with technology all day every day. And why traditionally you know I’m 55 so like I would be from the old school, there would be a sense of nervousness more the fear of the unknown. But I just want to give you a case study about my own personal experience I and we’re middle of May now 2020 and I tested positive for COVID. In Ireland two months ago, I was lucky as a physician because I was able to keep track of my vital signs, and particularly my oxygen saturation, which is a very earlier a very early signal of whether my lung function might have been decompensating. If I didn’t have that information, I would have been really nervous but on behalf of my patients, I was just hoping that I would have that near patient, constant connected technology available to me. And that is what physicians are now prepared to have as a as part of their armory to enhance as you describe the special touch that they have with their patients Nick.

Absolutely. You know, I think that one of the things that’s interesting, I can’t I can’t remember exactly where the quote came from. But there was one great thought leader that said that physicians will not be replaced by artificial intelligence, but our physicians that don’t leverage artificial intelligence will be replaced, right. I mean, it’s it’s that I think that’s an accurate way to look at it.

So, Nick, that is absolutely very true. And, again, maybe one case to illustrate to the critical nature of how actually AI has it already impacted healthcare in general is the fact that 17% of patients admitted for heart failure are readmitted within 30 days. And not only that, but 30% of those discharge heart failure patients are readmitted within 90 days. So, they, they looked into an AI solution that would actually assist with this problem because, you know, roughly it costs $4700 a night for hospitals there. So if we can reduce that, that that the readmission rates, we are talking about billions of dollars in saving. So they came up with an AI solution that would actually do the monitoring of the heart rate or the respiratory rate, the the sleep and body posture and other baseline of that nature and they actually came up with a platform analytical platform that would that all within 10 days before we had the mission, already detected that this patient was at risk. So that preventive measure coupled with the fact that the AI analytics already predicted that 10 days prior, we need to assist this patient, because there is a condition that is worsening. So using AI, they have reduced the readmission rate by a tremendous amount. And I think that’s, again, in the prediction. This is another fact is that 80% of the time AI was dead on spot on in terms of detecting the patient’s condition. So again, this is just one illustration of how AI today has made tremendous impact in healthcare.

Yeah, you know, I think about the genesis of that. I mean, One of one of my past clients and now good friend, Dr. Rich Milani, of the Aashna Clinic, you know, he was one of the first persons to use something as simple as one of the early generation AI watches to, to measure just blood pressure. And just by using that technology alone, they were able to reduce readmissions into the hospital by 50%. I mean, the cost saving was colossal, not to mention, you know, the significant improvement in patient care. And, you know, I think that when we, we look at AI, the thing that makes it interesting to me, is the fact that as we increase data sensors, in other words, as long as as long as we’re increasing, which we’ll continue to do, the ability to get different bio signals off a human subject, we’re going to need to find a way to aggregate billions of daily bits of data and to then understand that data and and report the data out in a way that provides early detection and early intervention. And that’s what’s beautiful about AI. It’s a very, very effective way to look at lots and lots of data. And then to understand the meaning of the data. And, you know, now we have digital stethoscopes that rather than just listening to the heart and the lungs, it’s able to listen to nuances that, in many cases aren’t even audible to a human. And then to take that data to be able to use it in a way to understand a tremendous amount of richness. I was at a hackathon a year ago where they were using iPhones and holding them to their your chest and breathing and using AI it was able to detect 20 different forms of respiratory problems. So it’s it’s really a servant of the caregiver. I think that’s the way we have to characterize it. It’s going to do the kind of the grunt work if you will, and and then provide through dashboarding data that will allow the doctor to be able to make far better choices.

Yeah, I agree completely with you about the dashboard, Nick. And I also believe that there’s another perspective another dimension of richness. Miari, I completely concur with your stats around admission and readmission rates and heart failure. And also when we put ourselves into the mind of our patients who’s at home, perhaps are in a care home, and they have the perpetual touch and they’re connected with their physician virtually and they know that qualitatively the confidence that that gives to that patient that they know that they’re always in contact virtually with their care team is immense. So we can describe the financial impact around $4700 per night stay, does the quantitative impact rent quality of life and how feel the patient feels good about themselves and their well being. And, Nick, we’re on a wonderful journey together, where we’re looking at models that can provide that health care cure to shift from hyper intervention to a prevention model. And to empower patients to have ownership of their perpetual connectivity, the data ownership pace, we can tease out, and that’s an issue, which is for another day. But I as a physician, I’m hearing now more and more patients who put into their apps, the symptoms that they’re feeling, their vital signs are recorded. There’s another dimension of socialization because with gamification, now, after entering that data, and it sounds a bit trite, but it’s the opposite. They actually had a game of bingo so that they’re connected socially with all of their peer group in virtual circumstances. And in this day and age where we’re going through lockdown, that’s incredibly powerful. Absolutely, you know,

I totally agree Dr. Ray and to echo your thoughts. Actually, last year, last year, there is a company called vital patch, which is a health monitoring device and the size of a band aid. It’s a class two device and it has actually received FDA approval. And that little Band Aid size monitoring system has ECG, heart rate measurement, heart rate variability, respiratory rate, temperature, body posture, fault detection, and so forth. I mean, it’s the blood pressure, weight and oxygen saturation, all of that within that tiny little band-aid size, monitoring system. And because now it’s a it’s FDA approved that’s going to actually feel the data because I think right now the the issue is that in AI anyway in AI in healthcare is the fact that 70% of healthcare data is unstructured. What that means is that you know, you have the doctor’s note file in a cabinet and you have the, the computerized system that does patient data here, but it’s all disparate systems. So now with the with the advent of those highly advanced and highly optimized monitoring systems biosensors, we are now going to have data that is consistent that is clean, that is actionable, and solutions such as the vital patch with all those monitoring of body systems will allow us to really make AI an absolutely incredible tool in the hands of the patients. And more and more, I think these are these, there’s an agreement and even among the patients, because, you know, anything that’s new has always been there’s a reluctance to embrace it. But given the fact that, number one, it’s not invasive, it’s literally just a patch applied to your skin. It’s not invasive, it’s inexpensive, so it will reduce the cost of care. And so with that in mind, I think there is a there is a bright future for healthcare, and understand that there are people who have this fear of privacy, and I know for good reasons. But something that we need to I guess mention at this juncture is the fact that, really, AI is neither good or bad. In other words, it’s intrinsically it has no value. It’s how you use it that makes it good or bad. And for the low hanging fruit that we mentioned earlier such as the use of vital patch, I think we have a tool here that will allow for a an instrument that will allow remote monitoring of patients in a non-invasive way. And in a way and like you mentioned earlier a way it adds comfort to the patient to the fact that they can be they can be in their own environment, they can be at home, they can be in a in a in an environment that is that is known to them. And meanwhile, through the biosensors data is being transmitted to the medical system and been analyzed and provide absolutely incredible insights into the patient’s health.

That’s incredible. Yeah. And I absolutely agree. You know, it’s it’s it’s a tool. And I think that if it’s used thoughtfully that AI really is the future of healthcare. And I think that we have to, we have to ask ourselves, well, why is that the case? Well, if you take a look at the epidemiology of chronic disease, and you take a look at the economic systems that supports the current level of scale in healthcare, there is no way in the world it’s affordable unless we automate this stuff. And we’ve been automating things and finance and manufacturing and every other possible corner of the universe. But we’ve not really been as good about automating these sort of disparate grunt tasks that could be very effectively done through multiple sensors and through aggregation, evaluation and reporting. And and that’s, there’s just no question. That’s the future. You know, and also, when you think about the issue of privacy, the truth of the matter is that will eventually go away. Initially, we’re always concerned about the so called surveillance economy. But you know, when you look back at Amazon in the early days of Amazon, people were widely claiming that Amazon was a guaranteed failure, because nobody would be willing to put their credit card on the internet. And, you know, it worked out okay for them. So I think when we look at AI, we have to realize that it’ll be protected through technologies like blockchain. And and what I what I really like about the idea of using artificial intelligence as an incredibly powerful tool to keep people healthy and to find disease processes early on, what I like about it is that we can now add continuous monitoring sensors that we really couldn’t do before. In our lab, one of the things that we’re really fascinated by and doing some research on today is what is the what is the what happens if you monitor the way in which people move their heads all day long and, and we found that there is this thing called head movement AI, and and what happens if we monitor some of the nanoparticles in the human breath, well, we now have breath AI. And what about if we listen to the modulation, the inflection, the pauses, the volume, and all the different nuances of the human voice? Well, it turns out that there are ways to potentially identify certain, you know, neural pathology. And so we now have voice AI. The point that I’m making is, is that when we can turn the heavy lifting of the analysis of lots of data over to the black box, then we have the ability not just to monitor traditional biomarkers. I think it gives us the ability to now monitor things that we never even dreamed of before. And that’s where I think we’re going to find some amazing discovery.

Going back out to the mark to our constituency, again, as an application example, the remote areas of the US, west of Ireland, Australia, we’re going to be talking about how we can serve those populations in our forthcoming documentary, fixing healthcare, how we will be describing how, during our training, as we work together as a team, we can provide a service to remote communities. You can’t like in the day of Dr. Michaelson in Iowa, be going out to do home visits in every patient’s home as you described in The Healthcare Mandated, your soon to be published book Nick but what we can do as a healthcare team, a physician, a nurse, a PA, on a primary care system can use the data that we’re able to gather from patients out in remote areas, and then we can avail of the AI to synthesize that into a meaningful manner to manage chronic disease and to be able to pick up the patients that are decompensating. So this is a way for us to be able to plan healthcare service delivery to remote communities for the next number of decades going forward. And I believe IBM through Watson are doing some extraordinary work in AI. So I think that our engagement with industry industrial partners in this space would be a very exciting journey together.

Yeah, absolutely. And what it is for innovators is a new tool that allows us to do crazy cool stuff. I mean, when you look at even you know, medical imaging, you take a look at an image and you know, we look at it visually and and we don’t really pull a magnifying glass out and spend hours looking at it, but AI does, and we’re now finding, you know, things that you wouldn’t see normally, you know, an MRI that AI can can Fine. And the success rate of leveraging AI in medical imaging is just really, really, really exciting. So I think that you know, the future and we talked about one point I’d like to make is that we’re all cast members in the upcoming film, fixing healthcare. And and this journey has been really interesting. You know, I thought I’ve seen it all. And I’ve learned so much from so many amazing thought leaders, that all share one beautiful vision and that is to really transition from the old fashion, hyper interventional model of reacting to sick people. The overwhelming majority of the economic impact in the way in which we compensate and the technologies that we use are all about reacting to sick people. And it turns out economically, it’s a bad idea. And it turns out from a humanism perspective, it’s a bad idea because we’re letting people get sick and the farther they go down the disease process, the less tools and options we have for patients and and the more expensive it is, so this is an area that I think is going to be really exciting to really monitor people find those disease processes early on. And as you pointed out, Ray, constantly let that patient know that, you know, they have their doctor on their shoulder, watching them 24 hours a day, non invasive and intrusive way, but in a way that they develop a partnership for their health. And and I think that, to me, is the most exciting part of AI.

And to echo your thoughts, Nick, I think it will be appropriate at this juncture to quote Bill Gates who said that treatment without prevention is simply unsustainable. You know, we cannot go on with feeding people pills when they’re sick, when we can actually do preventive medicine and avoid to for them to be sick in the first place.

Absolutely. When you look at the entire history of healthcare, from the first-aid era, to the infectious disease era, to the Modern medicine era to the hyper-intervention era, all of those eras, all of that early days of healthcare had one thing in common, it was reactive in nature. It was sickness focus. And I think the big shift that we talked about in the film, which is so exciting is that we are now really at an amazing strategic inflection point where we’re going to leave those old fashioned approaches which served us well into this new era of prevention, prediction and anticipation. And that’s really going to be fuel through wearable technologies, continuous patient monitoring, and certainly AI.

Absolutely. And to to add to that thought, Nick, I think we we are entering a phase it’s called the datafication of modern life. And datafication essentially, is the concept that all our our daily life is essentially without even us knowing it. You know, when we die When use Google Maps, it’s you know, data is being gathered and being used to guide us in the shortest way and fastest way. We are, you know, a lot of people wear these Fitbit watches and that’s all data driven. So the datafication of modern life, I think will feel AI will make it a tool that will absolutely and tremendously impact our lives and especially our health in a in a very positive way. And there’s also the phenomenon called the decommoditization of healthcare devices. And by that the term essentially alludes to the fact that more and more companies are coming up with those absolutely incredibly small efficient because usually in the past when we talked about medical technology, we we see these big machines and all these, these huge and expensive array of medical equipments. But the decommoditization of healthcare devices is a phase where, you know, those wearables will be becoming commodities and they will become, you know, a ubiquitous, a tool for patients to be used and within their reach. So I think we are really entering an absolutely exciting phase of healthcare right now. I agree Miari and the balance of this is my parting message. Nick, my parting message is that there will be a balance between the scientific data collection and the AI applied to that with the artistic approach for the patient gains the compassion and empathy has that relationship with their caregiver team and really feels as you said, Nick, that they have their physician on their shoulder with them 24/7, and that is the future of health and well being it as patients become more empowered. feel that they are responsible for their well being. And this will be an enabler for that future journey.

Absolutely right. That that is an incredibly good point is that we we have to maintain that equilibrium between the fact that you know, we’re dealing with humans, not just digital nodes, right. And so, I’ve learned a lot from you Ray about the concept of science and art of healthcare. And I never, it always sounded trite to me until I understand I understood it from the richness of what I’ve learned from you. And I think that that is so critical. And again, it is additive here because the two things that doctors and patients both need is more time and more data. And if we can make the data somewhat invisible, and then we can talk about the human connection and understanding patients from an ethnographic perspective and understand them in their family unit and within their tribes and within their social challenges and so on. And that’s the art that is so critical, and it’s not that is not going to be turned into machinery that’s for sure.

Absolutely.

Well, listen guys, we are out of time that seemed to go by we’re already at 29 minutes and I really, really appreciate it. I know you guys are busy. I love the fact that two of my cast members and partners on this journey on fixing healthcare were able to to share ideas as we’re in the middle of production of the film gives listeners a chance to kind of get a sense of the philosophical ideas behind this movement. Listen, guys, thanks again so much for joining me today. This has been another episode of The Healthcare Cure.


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