[MUSIC] Welcome to today's round table forum. This topic will center on the future of health IT. What things will look like five and ten years from now? How patients will interface with their doctors and healthcare institutions? Today with me is Sadipto Servastiva, senior director of e-Health Innovations and IT, Matthew Grove, senior director or IT governance, and Dr. Ashish Atresia, gastroenterologist and head of the Mount Sinai app lab. Ashish, let's start with you. How do you think patients will be interfacing with you in the years to come? >> I think in five or ten years, it'll not be surprised that most of the care will be virtual. And lot of patients or clients, consumers going to the health systems. The healthcare will come to them, wherever they are. Kind of picking the same analogy of banking, I don't have to go to a bank now to deposit a check. I can use an app, take a picture, and the money gets deposited. I think it's going to be very much the same in healthcare. We already seen the trend. And I believe in a couple of years we'll see telemedicine, secure messaging with doctors, kind of becoming main stream. We call it like water. The health systems will not even think of second time of using telemedicine or secure matching tools. I think with this virtual care, what I really believe will happen is, taking the code from my fellow colleague from Australian health system. Instead of health systems and the doctors being the drivers of the health car. The patients will actually be the drivers of their health with the doctors, providers and health systems being sitting in the front seat and guiding them. So a lot of our role will become navigation and guiding in the health system. And providing care when they really needing the hospital for a cure. But most of the time the patients and the consumers will drive healthcare. >> And now, you as a gastroenterologist, you're devoted, a significant fraction of your week is about procedures, right? Colonoscopies, endoscopies. >> That's right. >> And for many years, for decades in the US health care system, the incentives were really aligned towards doing these procedures. How are the incentives changing? And how can technology help patients adopt a more patient-centric approach? >> Absolutely, I think there's one favorite topic of ours when we do colonoscopy, which is our biggest so-called revenue generation. Colonoscopy is advised for any patient, any person above 50 years of age for colon cancer screening. It's a very expensive procedure, around $4,000, considering the hospital costs. But one fourth of colonoscopies have poor bowel preparation. Which means you will not find any other procedure, when you are going through a procedure, with all those diarrhea like moments, to clean yourself up. And 25% of the time, it's not clean and the procedure has no value at all. So, right now there's no incentive per seen in the health care system to make sure the person has a perfect bowel prep. Because if it's not perfectly clean, the person comes back earlier and you still pay for it. >> Twice, yeah. >> But as we move to at risk population and very soon from Mount Sinai. One forth in couple of years population may at risk. Suddenly, we'll not only lose that spot for doing the procedure if a person has poor bowel prep. The health systems says they'll become partly insurers will actually be at the cost of having a patient come back. So, I think it seems very distant to many health care leaders right now, but it's not distant. It's happening very fast and suddenly the incentive will be to make sure every patient gets a perfect bowel prep. >> Which is what the patient would want, anyway. Why would they subject themselves to the same procedure twice, yeah. >> Right. And only their apps and technologies which will guide the patients, we actually did, it's around 50 kind of things patient has to do in a checklist to make sure they have a perfect bowel prep. >> 50? >> Five zero. >> Wow. >> And we just give out a paper right now, and we believe all of these things will happen. And the paper by the way is given at a tenth to 14th grade level. So there are already apps, not only here but actually across the world. In Japan, China, multiple studies have shown. You can even use Whatsapp to give timely those information that gets to patient at the right time. >> Feedback information. >> Exactly. And that has lead to signficant improvement in terms of poor bowel prep. So technology is there. There's a need, we just have to turn the clock in our expectation to make it happen. So I think these kind of technologies are going to become really mainstream in the next couple of years. >> Great. Great, thank you. >> Those are great examples. As we sit here and look into our crystal ball, and any time you look at the future, you kind of draw a straight line from what you see around yourselves right now. And maybe you come up with the right answer or not. But as you look at what's happening, the noise that's out there, there's a lot of talk about devices that gather data. Gather data about your walking, what you're eating, you know how your blood pressure is doing. How different parameters of your whole body is doing. And right now, there's no real market to figure out. Well, what do you do with all that noise that it be generating? But I do believe that, as things get more sophisticated to analyze these data and more trends come out, we will be able to predict a lot more things much better. We can look at tell tale signs of certain disease conditions that maybe you know an indicator of an onset of something. And maybe hopefully, especially talking about the risk population intervene earlier and be able to do something about it. And I also think some of the attitudes towards the whole risk mindset that we have will change. Because if you look at it you know we as a health system require a lot of evidence that, this works or doesn't work. But if you look at consumers, they don't. I mean there's a new study every day about coffee's good for you or bad for you, or chocolate is good for you or bad for you. And people design their lifestyles around the latest New York Times article. And if some of these tools with variables and with apps and so on become more mainstream, people will start embracing them and doing more things with that data. Presenting it to every marketers of data who can mashed it together. And give them specific advice about them as patients. And to build upon, actually it's really cool example of the patient being in the driver seat. Let's also be prepared. Who knows where the patient might drive? The patient might drive in a direction that is completely unknown to us. So we have to be willing to modify our workflows and behaviors as a health system to accommodate where they take us. I mean look back to 1999, and the websites were completely different. As what they are right now. >> Right. >> So we want to believe that it's going to go a certain way, but let's also be ready for the ride as to where the patients take us. >> Right, yeah. >> And I think you bring up a great point right now. I'm generating heart rate data and step counts and you don't have the capacity to share it with my doctor. Let alone, would I expect my doctor to be able to interpret that and give me useful feedback about how I'm exercising or sleeping or any number of things. But I think patients are going to start to expect that and healthcare systems should embrace that. It's an opportunity, if we don't, then you know consumer like companies will spring up and take advantage of that. Matthew, you are involved with IT governance and really helping to align how information technology commits a health care missions and ambitions. How does that play into what's double stand? >> In a big way because what we're seeing. First we've seen the health IT industry within the provider environment. From a governance perspective really evolve. So if you go back 20, 30 years ago, IT drove any IT project. And with the advent of electronic health records, that's when we saw that begin to be a problem. Because we had IT people trying to automate and implement solutions for providers, for physicians, for nurses. >> That would work fine for the phones and the networks and the PCs, but not for the electronic health records. >> Exactly. And not for the clinical transformation that was required, and so what we saw was, we saw the introduction of the role of the Chief Medical Information Officer. So a physician was usually embedded within IT, who can provide that linkage. And provide that insight and feed information from that pool of users to IT to better implement it. And, so we've seen that IT grew up and really become more aligned with the business. But what we're seeing now is that even the business itself, and the roles on the business side, are changing. So first of all, we have roles today that we didn't have just a couple of years ago. We have a chief patient experience officer, who we are aligned with. Works closely with. We have an executive vice president for population health management. And this is an area, she's mentioned earlier, that as we start to become not just providers but payers. And as we start to assume risk for our patients it's in our vested interest to make sure that we're taking better care, and optimal care of those patients at the best cost. And that means leveraging technology where we can, to make that happen. So whether it be through monitoring or through a glucometers or through the use of virtual care and telemedicine for visits. We used to focus on specific cohorts of disease groups, so we would take risk for certain types of diseases. Within the next three years, we're going to be taking risk for everyone that crosses our door. So we really need to be aligned with them and be able to deploy solutions that meet the needs of our patients and the organization in the optimal way. Trying to kind of find that perfect balance between risk and reward, between benefit and cost. >> And I think it's going to be a very interesting journey. I'm certainly looking forward to it. But at the same time it's not going to be easy because resources are limited. The risk thresholds are pretty high. And I think as, people who are looking as to how things will evolve with the next five to ten years we have to be polished. I personally am very polished about this thing. Because while the data is not clean right now, while there's a lot of noise. If you keep at it and we gather more refudal heart rate, I mean because right now you're gathering your heart rate from maybe since the Apple watch came out. But, what if he'd been gathering it, what my child starts gathering ever since the age of seven. And at 27 maybe he can start seeing some trends. Same thing about blood pressure levels and heart rate and so on. There's a lot of skepticism in the industry about hey, will this work or will this not work, it's not been proven. It will only prove itself if he keeps trying at it and stay at it and find the resources to invest in those things >> Yeah. If I- >> Go ahead >> If I may just add too, I think part of it is we haven't really build the infrastructure to test what works, what does not work >> You anticipated my question. That's great. >> Right. So there is hundred thousand x more innovation happening outside the health systems than inside the health systems. Right and really coming to the concept of what we want to be innovation partners. If great innovations happening outside, how do we really adopt that and adapt it for our patient population? But there's no good model of how we take innovation happening outside, prove what works, not just to we as our health system alone. Because a lot of I think the issues currently happening are the chances, we at each health system is trying to work on its own innovation pathway. And instead of working in this siloed pathway, we have to embrace the concept of open innovation. But we collaborated with other health systems because everyone is in the same boat. Right? And no one has the bandwidth to do it all by themselves. So the only way that we can really accomplish it is as a team, as a collaborative engine. So if we do multi site pilots, multi site studies, then we don't have to duplicate necessarily the results of each pilot. And we are openly sharing if another health system does a pilot and they learn something, they openly share with the rest of the community. That's how the whole computer science has built. That's how the whole medicine has built, that we learn and share in conferences. And I think we can surely walk that path, but will be thousand times more efficient if we share and learn from each other. >> And you're saying that what needs to be studied is simply the new forms of care delivery. Even whether a virtual visit is safe, for each specific condition, it's not yet really well defined. >> That is correct. >> So, conducting this study, are, is it a luxury? Or is it a necessity? That we don't implement anything until we have solid evidence. What do you think? >> We share this concept of, how we have evidence based medicine. Before a doctor has prescribed any app or a medicine, you have to have evidence behind it, [INAUDIBLE] I think we need to come with evidence based digital medicine. But really, I think we need to be innovative in how we study it, in fact. We should not take the same concept of randomized control trials and say two year study blinded and do it because we have to come at a very fast way, maybe a three month study. Maybe it has to be a pragmatic controlled trial. Maybe we adjust the dose of the intervention. And I think, lot of innovation in the health system should be on how we even test it and not just take 20th century ways of testing and implement it. So one example could be building use case scenario for telemedicine. Can we just have, instead of one site study implementing 20 months and then generating outcome, how about we do many pilots across 20 different sites or 20 different specialties. And then run it for four weeks or eight weeks and say, is this use case scenario really creating value or not. And then publishing. >> Because when we have these long time tables that we're accustomed to for drug trials, the technology marches on without us sometimes. And we've seen that over. >> I think we need to take it also a step even further and think about what it will look like, what it could look like, in the future. I had an interesting experience where, when I was eight years old, my father recorded my eighth birthday party. And I'm old so, it was on super 8 film, which over the years was converted video and then to digital. And a few years ago, I was watching it and I remember looking at the house that I grew up in. And I'm thinking, it seem so old fashioned. And I was looking at it like everything is very old. And so, I look around my own home and thought, what are my kids when they're my age going to think. Looks old fashioned about this right now. And the first thing I thought of was, they're going to say, what are all those wires and cables? >> [LAUGH] >> Why did you need to plug things in? Didn't everything operate wirelessly? And then that was hammered home just literally yesterday. My son's going off to his first day as freshman in college, in a couple of weeks. And he got the suggested packing list from his university, and he said, I think this must be an old list because they make reference to CDs. >> [LAUGH] >> And then he said, and what's an Ethernet cable? >> [LAUGH] >> Yeah. >> Because my children have grown up in the era of Wi-Fi. So I think, we need to really sometimes just take a step back. And allow ourselves the luxury of thinking what could this look like. What will this look like. And think about how we can make that world come to pass. >> But as we've talked about before, a lot has to happen for a vision to be executed and for a distant kind of imagination for how health care will be. We have to line up the regulatory environments, there's the hospital mission, there's patient expectations and then there is the workforce. How can we facilitate this and like how do we prevent going in the wrong direction? Is this a governance question? >> I think it is, and it's kind of what I alluded to before that we need to be in lockstep with the business. And it's a progressive follow and lead because the business can tell us where's the industry going, where's the healthcare industry going. So that we can be there to support that. But at the same time, it's our role to educate the business side with what's possible through technology. And let them see what's possible to assist making that happen. To make it effective. To make it profitable or at least efficient, and so really to partner with business going forward. >> And Matt makes an excellent point there. Because even looking at our portfolio of solutions that have succeeded within our ecosystem. The ones that have aligned better with business and their workflows and their needs, sometimes even for revenue or cost savings resonate so much, so much more. And that automatically doesn't mean that it's not patient focus. You'll talk about something like simple access or patients having access to schedules or the doctor's note. If leadership recognize that's the right thing to do, invest in it. There are returns that you see in areas like patient satisfaction which is a huge thing for us. In areas where you can catch things just by engaging with a customer a little earlier, back to the whole point of prevention is better than cure, which is what even my grandmother used to say. >> [LAUGH] >> That leads to better outcomes, better value for the patients. Well that's a good note to end on. Thank you, Sadipto Servastiva, Matthew Grove, Ashish Atresia. I'm Nicholas Jeans. Thank you for watching. [MUSIC]
