You know, it’s really exciting for me to be able to share my relationships and the stories of some of the smartest people in healthcare. In the great honor that I have as serving as the Chief Innovation Officer at Western U. I’ve had a chance to meet some incredible people. And what I love about the the teams that I’ve met and the individuals I’ve met at Western U is that they’re completely and totally dedicated to improving the quality of patient care. And I love that mission. And that’s really what this entire film is about is how can we leverage technology and new clinical models and new economic models to be able to deliver predictable quality and safety to patients, while at the same time reducing cost improving access, especially access to underserved communities. And that’s what this is really all about. We can do this. It’s not easy, but it’s possible. And as we talked about in all of our podcasts, the three elements of change is that we first have to recognize that healthcare is broken. I think we all agree on that. The second thing we have to realize, and this is hard for people is to believe that it’s fixable. And in fact, Dr. Barnes just mentioned to me prior to the broadcast here, he said, ‘Hey, Nick, anything that we can break, we can probably fix’ and I love that. And then the last thing that we have to realize in this continuum is that we have to fix it. And that’s really, in many ways what this movement is all about. Healthcare is broken, it’s fixable, but we have to fix it. If we’re waiting for industry and drug companies and device companies and insurance companies to fix it, well, my sense is we may not like the fix.

So right now I’d like to introduce really and truly and this I know this sounds really patronizing, but it’s true. And he knows it is that Dr. Edward Barnes is one of my favorite people on the planet. He’s just a super cool innovator. And he and I have become close. Well, at least I know I like him. And in the fun thing about Dr. Barnes is that he is such an innovative thinker and I love the fact that he has plasticity in his thinking he sees that this stuff is fixable, and, and we have a very, very strong partnership. In his role as the Chief Clinical Innovation Officer at our medical school. And me in my role as the Chief Innovation Officer, we hang out a lot. We bounce around ideas, we move things forward. And it’s such an honor to have him with us today. And of course, I have as always Dr. Ray Power. Dr. Power is chiming in from Dublin, Ireland today. And of course, he’ll be asking questions while we have the great honor of having Ed on the phone with us today. So with that being said, Ed one of the things that we’re really excited about, and we talked about is one of our four elements in the film is that if we’re going to fix healthcare, we need to change the relationship with a primary care physician with all doctors and all caregivers in general. But that that sort of air traffic control a primary care is really, really important. And we believe that and I sense you can relate to this is that I, as I see our medical students walking up to pick up their diploma, I’m thinking to myself, there are four unfortunate battles that they’re going to have to wage.

Number one is that the economic system punishes them for spending time with their patient. In my consulting practice, I work with consultants that do patient throughput, optimization, yikes, that’s actually a thing. It’s really a fancy way of saying let’s get patients through here as fast as we possibly can. And believe it or not, they’re actually using models that they’ve learned through fast food restaurants. It’s bad, right? So time is something we have to give caregivers.

The other thing that we have to do is we have to give them more data. When a patient presents themself in a primary care setting, the only thing they get is maybe blood pressure. They’ll listen acoustically to the heart and the and the lungs and maybe shove an otoscope in the air, get blood pressure, as I mentioned, and and maybe temperature, but it’s a fractional sliver in time. So we really need continuous patient monitoring and other resources to get rich data for these great caregivers.

The third thing that we need and it’s surprising to me and I can’t wait to hear what you have to say about this is that the amount of time and resources that we invest in medical school to teach caregivers, to be wellness practitioners and and nutritionists is zero, essentially there’s some but not much. We have an automatic trigger mechanism of sickness intervention.

And then lastly, we really need to be able to create new economic models that weaponize these things. They need more time. They need better wellness resources, and they need better patient data. So with that being said, assuming that you may agree with this, how do we educate the healthcare practitioner of the future Ed?

Well, Nick, I first like to thank both you and Ray for having me here today. I appreciate being able to share my thoughts and voice with your community. And I think it’s very important that our students have a voice in this too because they are the doctors of the future. So as we start to build that next gen doctor, like I like to call them they, they’re going to be equipped with a lot of different tools that I can personally tell you as I was going through medical training, these tools were not enforced. I understand the environment was different healthcare was a little bit different than what we see on the horizon now, but these tools that we’re going to equip them with will start to prepare them for, for a lot of the things that you you mentioned, I like to, quote, a term or coin a term that Abraham Marchese at Stanford frequently uses, which is, how do we have a high touch? So this is a high tech world. So as we start to develop new digital technologies, really deploying a lot of data, what skills will these future doctors need?

So I would first say, they’re going to need to be critical thinkers, they’re going to have to have training in analytical thinking, because in support of your view that our doctor’s are going to need to have more data in their hand, they’re going to have to learn how to analyze that data and then not only analyze it, be able to critically think on how they’re going to use it in the care of their patient. And so as we talk about data, I think that our approach has been at Western U to really point out what their role will be because I think there’s sometimes a fear that if we have data if we have technology that the doctors will be replaced. That’s a farce. It really is. I think that we there’s just an evolution that really needs to happen, because what you’re going to be doing is empowering these doctors of the future with this information. I wholly agree with that.

The other point that you made about about pushing upstream, the type of care that we provide meaning focusing on maintaining health and wellness, starting at a young age and even in folks that are older, that may have one or two diagnoses is also wholly important. You’ve termed it sick care which I, which I agree with, if you go back to 1910, from the flexner report, which really scientificized, which is not a word, the way that we approach healthcare, you were dealing with the snake oil salesman, all of those things that were going on at the time. And so the flexner report really shepherded in this new era of making sure that there was a scientific basis for medicine, which I think was obviously a very positive step. But from that was birthed the way that we actually train medical students today. And we’ve been training since 1980. In the same model, that I think is unsustainable when we have evolved so far from 1918. In so many ways, as a country as a unit as, as a world. I don’t know how we still train medical students in the same way and with the approach of sick care diagnoses treatments, it’s too late. It’s too late when we’re engaging these patients, it’s a lot more expensive care. So we have embedded lifestyle medicine, we’ve embedded wellness care we’ve been. We’ve embedded exercise and improving eating habits, mindfulness, we’ve embedded it throughout our curriculum, but we can always do better. Because the ultimate structure our students get tested on in their standardized exams, really encompasses sick care. So it’s hard to eradicate that when when they know they have these licensing exams that they have to face the focus is on that so there needs to be an evolution across the board. And I would say that we are trying our best to kind of promote that model because we do clearly see that that’s going to be the way of the future.

If I might just jump in Ed and it’s a pleasure by the way to reconnect with you after having met up with you in Pamona in May of 2019, and how the world has changed in the interim with regards to the challenges we have around traveling, but before to meet up with you again, please God in a month or so, I was really taken with what you said there about the high touch and high tech environments. And one of the aspects to the humanist experience in Western U campus in Pomona that really resonated and was infectious for me is the multi disciplinary approach that you adopt. And you actually have a privilege because you have a number, you have 11 health care disciplines on campus who are all working together, there is vertical integration, there’s horizontal integration. And when it comes to the interpretation of data, one of the components that we’ve been analyzing here is how our nurse colleagues indeed are actually more effective following procedures, protocols around what the triggers are, say the acute kidney failure, disease, that you’re so familiar with wants to create name and the GFR goes below a certain threshold that then triggers certain dynamics around medication review. And as we’re becoming in, as you say, to go upstream in our rationale to keep patients well, I’m sure you would agree that this type of a multidisciplinary team based approach is the way to go and it’s not the doctor of the future working in isolation, which have those artistic skills and leadership skills and working as part of an integration team. Would you agree with that?

Ray, I couldn’t probably say it any better than you did, but I absolutely agree with it. I think the team based approach will be essential in this the complexity of the problem that we’re dealing with already mandates that it’s going to be a team based approach. And with that team, the doctor, as you pointed out, will probably be the leader. They’re the most in depth training, they’ve really got the training of critical thinking and analytics. But I can tell you, my nursing colleagues, they’re right there on the front lines, managing the patient, hour by hour, and they’re the first to actually see and get the data. So as I’m discussing my patients, even today, I’m asking them what they see what what they what the patients feel, what, what they feel with their own hands, and sharing with me the data. And then the final question is, what do you think we should do? Where should we go from here? As a nephrologist, by training. We’ve been doing team based care for decades as we work in dialysis centers with our social workers, our nutritionists, our nurses and support staff to actually get the outcomes that we really need. Nick alluded to it earlier too focusing on quality based care that is impossible without a team. Because if it’s, hey, I saw the patient, and I can bill because I saw the patient for 15 minutes, then people are just going to only look at a patient is not going to really be based on their quality outcomes. I can tell you, in my practice, we really, really do reinforce quality as the outcome. In my clinical practice outside of the dialysis center, I’ve recruited our farm D, I have a nurse practitioner, and also I work with our dietician within the clinic. And our goal is the outcome of the patient. We want to make sure that we maintain our patient’s creativity over time, and that can’t be done in a vacuum and alone with all the volume of information and all the care coordination that needs to go on for the patients today. So I can tell you personally for my practice, that’s the way I view it. And our students are embedded all the way. From the first year that they step on campus, they’re partnering with me and my clinic and several other clinics like ours, to actually get embedded experience with team based care.

Yeah, that’s excellent. That’s such an important part. And that’s the great part about Western U is we, we really probably have the best petri dish of what integrated healthcare looks like. And when we get a chance to work, even interesting things like having a veterinarian, you know, college, it’s, it’s it, you would never think that there would be similarities there were, we’re doing some innovations with vet med right now where they’re doing some incredible things around video and and surgery and and just it is so neat to cross pollinate innovation and to see how we build out this team based approach and in patient care and earlier.

Sorry to interupt you Nick, but if I might move on to discussing telemedicine with you, because it’s interesting how through the C19, requirement over the last three months now, we’ve shifted our emphasis around doing the face to face type consultations with a combination with virtual consultations via their telephone telephony, our video consultations. We both agree that the human touch the hands on approach is absolutely crucial and we will never forsake that. What’s really striking me when we’re doing our cycles of care for chronic disease management for patients with renal disease, heart disease, diabetes, the actual video consultation that our nurse practitioners our A and P colleagues or PAs are able to carry out. It’s actually very rich, and it definitely will be something that we’re going to take and leverage going forward into the future. My day is so different to four months ago, I now turn 50% virtual when honestly I was doing 90% face to face. I do need for us to keep that kind of Patient Centered Medical Home models so that we do track our patients and invite them back regularly. But do you feel that telemedicine is definitely now part of our armory and as the Chief Clinical Innovation Officer at Western U? Are you designing studies around that as how you’re going to embrace that in the future as part of your care plan?

Um, thanks Ray for the question, I could tell you. As Nick pointed out, telehealth telemedicine has been around for 8 to 10 years, people have really been investing their time and efforts into it. It wasn’t until C19 that we got thrusted into this environment rapidly. And I’m with you. I’m seeing all the advantages and the perks to actually integrating appropriately telehealth telemedicine into what we what we do. I’ve also been practicing telemedicine, I would say closer to about 80% of my visits right now. And I, along with my nurse practitioner, I think it’s really been rich, as you pointed out. I, I if you rewind two years ago, and you asked me that question, I probably would not have had the answer that I’m going to have now. I saw it as a way of the future for certain types of visits. They were just, I just couldn’t envision it for the types of patients I was managing. But we found a really good clear cut off of these are the patients we have to touch no matter what these are the ones that we have to see. And that’s clearly our dialysis patients that are in need. But for my peritoneal dialysis patients that take care of themselves at home, you know, on a day to day basis, I’m able to do that telehealth visit successfully, my nurse practitioner is actually able to reach out and do more care coordination which we missed probably, that in-between appointments that we were missing over time. And so as we talked about educating our doctors of the future, I can tell you that Western U, we really been going through this endeavor over the last six months, but it kind of got sped up as we enter the C19. environment. We hired a director of telehealth as part of what we’re going to be doing not only in practice, but also in training and then integrating our students into the care that we’re going to be getting because they will definitely need to be armed with the experiences of telehealth. And I think and this is without our patients having all the wearables that they’re going to need on their side to give us more data, and it’s still been a very valuable experience and it’s still going to be foundational for a lot of these appointments that we can definitely deploy through telemedicine.

So do you see the curriculum changing even further, like the joy and of communication that Nicholas J. Webb is in our company at the moment, and we we need to bring him into the teaching because the ability to communicate to be able to articulate your thoughts when you’re not in the same room is a different skill set. You and I feel a little bit nervous in this environment when I started doing the video consultations, I wasn’t quite in my comfort zone. So do you feel that we can actually include that more in our not just our physician but as I said, our nurses, our PAs, our other healthcare professionals, so that they feel comfortable in the environment that that Nick feels is not just home turf for him?

I think so. I was gonna say in my intro but I felt like I was talking a little too long I was going to discuss about I was gonna discuss communication, because that is definitely one of the key tools that doctor the future that next gen doctor, they’re gonna need that. Because we’re going to have artificial intelligence, we’re going to have a lot of the data, we’re going to be integrating telemedicine, the doctor of the future will be that communicator. They will be that expert who’s also bringing care and compassion to the way that you deploy these messages. And how do you reach through a screen or a telephone to still show that care and compassion and also be able to communicate what the outcomes and what the treatment plans going to be? And definitely training from folks like our adjunct professor Nicholas Webb and along with our new hire of director of telehealth, I think those are going to be very important in the training of our students.

Yeah, one of the things that the Center for Innovation is working on right now is a training protocol that we’re going to circulate to get feedback on in the next few weeks. What we realized is there are sort of two dimensions to the patient engagement when you’re thinking about the two dimensionality of digital right, it’s it’s not as rich. And what we what we have to do is kind of get back to the Dr. Michaelson sort of ethnographic approach towards patient engagement. And by that, I mean is that what we’re suggesting in this protocol that we’re developing is, it sounds corny, but beginning to teleconsult with a icebreaker, in other words to humanize it by to really weaponize it through a humanization to make it a, hey, how are you, to know, a human do you begin to consult to develop the icebreaker that moves you from the transaction of healthcare to the humanism of healthcare sounds corny. Now as a professional speaker, I do this all the time, right. I start out with something to let the audience relax and that’s really what we believe is the best way to start these telemedicine consults to begin through humanism because our patients have to trust us. And they want to be, they have to feel comfortable and sharing intimate things about their life and their environment.

And when we can understand them beyond a biological node, and as a human to understand you’re not going to understand their tribe and their family dynamic, and there’s stress sores and these other causal causal factors, but you can open the doorway for that dialogue. And that’s what we’re recommending in this protocol that we’re developing. In fact, we’re doing a video this week. I think the other thing that we have to realize is that there is a limitation to the two dimensional aspect of the telemedicine screen. It doesn’t allow us to have really the same power 90% of communication is physicality. We don’t see that as much physicality. We also even talk even to the granularity of the impact of the human voice. There’s a new body of work right now around what we call voice AI. So the way in which the caregiver uses modulation in flexion, the way in which they pause the way in which they use variations in pitch and key. Seems subtle seems like it’s no big deal. But when we’re trying to understand the patient at a human level and beyond a biological node level, we have to be thoughtful about these things. And the good news is this is very trainable.

And there’s one other piece before I finished my rant here on this is that the other piece is that, believe it or not, hyper consumerization is a big part of the future of telemedicine. Now, as an author that can allow people to rate my work on Amazon. It’s terrifying. But you know, what ratings do when you write books, it makes you a great writer, because nobody wants to have a one star review. Guess what, when I was involved early on with Blue Cross and in our anthem and their development of, of life, health. And one of the things that they did that was incredibly powerful. And it actually resulted in behavioral plasticity in the part of the caregiver is they developed a five star rating system. I don’t know about you guys, but every doctor I know is not the kind of person that wants to get a one star review. So here’s what’s important. It actually changed the caregivers behavior. And what they started to realize is, is that the customer experience was as important or certainly important as the clinical experience. Now, it’s easy to dismiss that because we’re talking about life and death here. But remember that customer experience or what we call CX, significantly increases the way in which the patient wants to engage the caregiver. So if we want higher degrees of pharmacological or regiment or treatment compliance, engage this patient if you want higher degrees of trust and bi-directional Full Duplex dialogue, make sure we deliver a great experience. So anyway, we’ll we’re going to post a video on this soon. And we’ll be working with Dr. Barnes and other geniuses around the university to mature this including our new director of telemedicine, but we really believe that one of the greatest opportunities right now is to is to train caregivers how to succeed in the two dimensional environment of telemedicine.

That’s it. And if I was just to add a little bit to that, Nick, it’s interesting how when we talk about humanism, the responsibility we have as compassionate physicians when we do video consultation is to take those verbal cues because then I’ve no doubt mood disorder has just really escalated exponentially with the problems we’ve had with the Covid-19 and if we’re able to avail of the consultation, even for rapid sequin CBT interventions to be able to give patients that ability to go back in you mentioned mindfulness earlier. And as well as looking after their kidneys or their hearts or their loans, if we’re able to introduce into every consultation, that initial engagement for relaxation, and then to be able to provide some support around techniques for relaxation, and to reduce level of anxiety. That’s what would get us a five star rating because it’s not so much what patients remember from a knowledge point of view, but it’s how they felt during the consultation. And you mentioned this to me several times over the last few artists, our intervention that we need to try to instill in our students the future that they have that.

Absolutely, I I really do feel that with the C19 world, and the social justice activation that we’re all experiencing right now, our current students have been energized, I can share that with you live, they have been energized by all of this where you would think they would all kind of curl up in a ball and step back and say, Oh, no, what are we going to do, but I think they’re really leaning into this. We’re going to be dealing with folks that are very socially conscious, that want to have that care, direct care, albeit through video, conference or live and to give them the skills that they’re going to need as humanists, as we’ve been talking about humanism is going to be important. We have a group of students right now who have decided that they don’t want to stop engaging with the community. So they’ve created virtual ways to do community service by letter writing campaigns to nursing home patients who’ve never who who can’t see their families right now because and that’s our highest risk group of patients right now, to actually dropping in different video conferencing tools into these nursing homes and having video conferences right like here so they can actually partner and share with the patient. That there is someone who does care about them during this time with their family may not be able to come into the nursing homes. We’ve had students who’ve actually created homeless initiatives during this time to make sure that we are supporting our homeless population, virtually so I feel our next gen doctors are showing us the way of how we should be engaging patients virtually or and also how you still exhibit care. In this new site, C19. Kind of in the midst of a social activation environment.

It’s interesting because we had a great conversation two weeks ago with Professor Crone. We are already getting a connectivity with the student body group for our Fixing Healthcare, The Healthcare Cure journey. So indeed, only in two days, we’re going to have a conversation with some of the representatives of the student group and what we’re seeking to do with this collective endeavor. And it’s no one’s show. This is a shared mindset, a commonality, a, like mindedness that we’re trying to share that we’re hoping and we’re inviting, and I know you extend as Professor Crone has, and it’s not confined to Western U. It’s across the whole continent of the states and Ireland and Australia where we have already got reach. We’re actually saying to doctors of the next generation, you say there’s a vocational spirit there that’s so tangible to me too, that they want to be conditioned for a very specific purpose about making a positive impact on other people’s outcomes. And in the same breath, they need to look after their own health to be able to do that successfully. We’re hoping that we might, I’m delighted that you’re going to be on the journey with us Dr. Barnes to be able to reach out to that group of colleagues as I would call them, for us to be able to shape the future together.

Absolutely.

Well, listen, guys, I could go on for hours. We are believe it or not out of time. I really appreciate Dr. Barnes taking the time to visit with us hopefully, we’ll be able to get you on again in a few weeks, we are actually going to do something kind of interesting. We are taking our podcasts to two channels now. So we’re going to go on all we’re, of course on all of the standard channels, Spotify, iTunes and all means of podcast distribution. But we’re also going to now start video recording the podcast to put it up on our YouTube channel so people can see the faces behind the genius. And we’re really excited about starting that next week. Well, listen, thanks again. And by the way, I you know, I regret that I didn’t get a little bit more your background, the beginning. Do you mind? I just kind of given me your your brief bio, because I neglected to do that in the very beginning.

Absolutely. So, as Nick said, we’re good friends, good close friends. Ray and I are on that same path. I am a nephrologist in training by training, I went to University of Kansas School of Medicine and was trained in the army at Brooke Army Medical Center in San Antonio and internal medicine. Also served in support of Operation Iraqi Freedom as a battalion surgeon. Right there on the frontlines run around tanks, then migrated back to train in nephrology at Walter Reed Army Medical Center. I joined Western U in 2010. And I’ve loved it ever since I love engaging with students. I love the innovative spirit of the institution, and the forward thinking the way that they are actually on the leading edge of technology and medical student training. I also love the integration of the 11 other colleges and programs that we actually have to actually train our students in inter disciplinary interprofessional education. So I feel like being at Western U a place to be right now. And I’m happy to be a part of it.

Thanks. Well, it’s you know, it’s funny I, I you this probably happened to you too, at some point, you fall in love with the place right? And it’s almost like a religion right. Energized by the amazing students that we have the honor to be able to serve there. I mean, I’ve learned so much from the students. And I’ve learned so much from my colleagues, of course, including you, and it’s it, honestly, it, you know, my wife, Michelle knows that Western U is my happy place out of all the things I do this is you know, as, as you get older, you really want to have impact. And this is something that I hope that I that I have some legacy and impact to be able to, in some way improve this journey for our students and and to have some way in which I can make that that journey for them better. Well, listen, everybody. Thanks again, so much for your time today. And we’ll definitely have you back on the program here again in the next few weeks. If you’re willing, I know it’s early. Dr. Power. Thanks again for your contribution today.


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