Powering Up Innovation in a Digital, Connected World


Lisa Carmel

Lisa Carmel

EVP, Global Strategic Partnerships, Veranex
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Atul Butte, MD, PhD

Atul Butte, MD, PhD

Chief Data Scientist, University of California Health System
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Gretchen Purcell Jackson

Gretchen Purcell Jackson

VP, Scientific Medical Officer - Digital, Intuitive
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Josh Makower

Josh Makower

Director, Stanford Biodesign & Special Partner, NEA
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Todd Brinton

Todd Brinton

Chief Scientific Officer & Corporate Vice President, Edwards Lifesciences
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Joe Smith

Joe Smith

Chief Scientific Officer, BD
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Insight and discussion about the importance of driving innovation in the medtech and healthcare industries in regard to an increasingly digital and interconnected world.


Lisa Carmel  0:09  

Hello, can you hear me? Great. It's great to be here. And good morning, everybody. This has been an incredible week and on behalf of ver next, we're thrilled to support LSI. I think we've been here from the inception. And after this week, I would I think it's accurate to say that LSI is at the is creating the epicenter of med tech right here this week, in particular. And speaking of which, we have this amazing panel, we're going to be talking about innovation, fueling it powering it up. And I thought that what we could do is kick off with some introductions, if you want to quickly introduce yourself, maybe frame quickly frame how digital is, is at your organization, and then share something that's fueling digital innovation at your organization.


Josh Makower  1:07  

Hi, everybody, I'm Josh Makower, our, the director of Stanford Biodesign, and Professor of Medicine and bioengineering and also special partner with NEA and the executive chairman of Explorer Med. At Biodesign, digital is integrated into, you know, every thought pattern as we try to figure out how to think about solving solutions, solving problems. The you know, we have an active digital course, which is really kind of interesting. And in terms of things that are fueling innovation, the team has come up with a really interesting open source product called Cardinal Kit, which actually provides a lot of the basic modules that allow anyone to build their own digital health solution. So deals with HIPAA deals with cloud storage, you know, and a whole bunch of other issues that are typical for digital health solutions. So it's a nice way to enable the ecosystem.


Todd Brinton  2:16  

I'm Todd Brinton, interventional cardiologist, I'm currently the Chief Scientific Officer at Edwards Lifesciences. I spent a long time 20 years at Stanford, 15 years as the fellowship director for Stanford Biodesign, prior to moving to industry. Been an entrepreneur started a number of companies, I was an engineer originally, before I went back to medical school. So I'll probably take a little bit of the con argument here in the sense that digital is incredibly powerful, I just have a difficult time defining what digital is. Digital is everything to everyone, depending on what you want it to be. We clearly, I think it's a very powerful tool, incredibly powerful tool. But I also think mechanical, electrical bilott. All these are very powerful solution tools. And I think it's just the context of what problem you're trying to solve. We definitely have a, you know, use digital platforms, at Edwards probably the most obvious is we have an entire business of predictive analytics in the critical care space. We have an entire team of algorithms of all sorts of AI ML technology that we're using for that, we're now starting to look at it in crossover, some are thinking about what we can use it for in our cardiac implants business. But I look at a little bit more as it's, it's a it's a very powerful tool. But it's not the end all be all. And I will tell you that the number of businesses, I'm one of my responsibilities, looking at businesses outside of Edwards, we evaluate and the number of things I look at that say we've got a problem with all this data, and we're going to tell you eventually what product we're gonna create with AI ML is going to solve everything for you. I just like to know what it is. Because I think you have to define what we're talking about. So that's my position.


Joe Smith  4:02  

All right, this is going to be a great panel. So hi, I'm I'm Joe Smith and, and much of what he said I just wanted to say ditto. So started off life as a geeky engineer, became a geeky cardiologist, interventional electrophysiologist. And have had worked in big companies, you know, like Boston Scientific and J&J. And some small companies, I built two little digital health care companies and sold them and so someone found value in them. And for the last, for the last 17 months, I've been the Chief Science Officer for Becton, Dickinson and BD if you don't know it, I completely understand it because we've met mastered I think stealth marketing. So 77,000 people last year we shipped 45 billion products into health care was several million of those are smart and connected products. And so I look at what we might call digital innovation, as is the opportunity to take, you know, it's often said it's taking data, turning it into insights, first information, and then to insights, and then give that to the clinicians. And I do that as almost enough. Because if you spend any time in a critical care environment where I think we both lived at different times, what you find is that in the average ICU, there are 40 devices that are giving alarms to the tune of 700 per person per day. And we are looking at feeding the busiest clinicians in the world with more data than they could possibly deal with. And so the way I look at at where digital can go is it's not just stopping at the insights, but it's actually closing the loop and making care a good deal more automatic, we've been able to do this with some simple things. You know, we've got now closed loop control for insulin pumps. But if we think Elon Musk is doing a good job and getting self driving cars, we need a little bit more automaticity a little bit more closed loop control in healthcare so we can take some of the burden off of the busiest people in healthcare.


Atul Butte  6:08  

Okay, wow. So my name is Atul Butte. I'm a computer scientists, pediatric endocrinologist, professor and an entrepreneur at the University of California. And I gave the keynote two days ago, so I'm not going to rehash all of that. But the University California is huge. We have a little Cal Stanford thing gone here on stage, on top of everything else. The three of us are from MIT help you to argue from will be arguing here, and that makes a good panel. But obviously, University California starts up companies and you've heard Agena Tech and a couple of our startups. But I represent the umbrella over the health organization, university, California health or UC Health. We have all six academic health centers all working together now. So that's UCSF, UCLA, Irvine, Davis, San Diego, and Riverside. And I in particular, I'm the Chief Data Scientist over that whole umbrella. So I'll be talking about one flavor of digital, the electronic health records, which I said two days ago are so old, they're new again. And we have all this data captured on every single thing we do and measure on a patient. You see, we have 9 million patients over the past 11 years, 50 million devices have been used. And like I said, we track every screw of every kit of every device, we implant because we know how to bill for those. And where I'm having fun is translating real world data into real world evidence. And yeah, well, we have a lot of data, but that's why we have artificial intelligence and ml and that's coming along the way too. So I'm looking forward to this panel.


Gretchen Purcell Jackson  7:31  

Great. Well, I'm Gretchen Purcell Jackson, I like to think of myself as a simple country surgeon. I'm from Nashville, Tennessee, although I did do 12 years at Stanford, as an undergraduate in engineering, med school, and then a PhD in Biomedical Informatics at the same place that Atul trained. I'm a surgeon and a scientist. And I spent 12 years as an academic clinician scientist at Vanderbilt, I still practice pediatric surgery part time there. And then I went and joined IBM Watson Health as their Chief Science Officer and their Chief Health Officer and I now work at Intuitive Surgical on Scientific Strategy. Intuitive, as many of you know, is best known for the DaVinci Robot, the robotics platform, and I work for the digital part of our organization. So we think of digital as everything that you can put into the robotics platform. So 3d models, imaging guidance, even AI, like don't cut that. Or everything that we get out of the robotics platform. And to be clear, Intuitive was born digital. So we have always had sophisticated software along with the hardware devices that help with maintenance and monitoring, to ensure that the device is reliably available. But we also know everything about what happens during surgery. So everything. So what instruments are used, how long a particular task takes how much a surgeon turns their wrist, when they are sewing something. And what I am most excited about is that that data can really allow us to understand what makes surgery safe and what makes surgery effective. So a lot of work has been done around surgical quality. And most of that has focused on patient factors or disease factors like is the patient obese? Or do they have poorly controlled diabetes? Or do they have stage four cancer so the surgery is going to be much more difficult, or it is focused on very simplistic surgeon or institutional factors. How long has this surgeon been in practice? Is this a high volume Center of Excellence? We when we know exactly what happens during an operation, we can start to associate what happens during an operation and the insights from that with clinical outcomes and that is really exciting. And we are just starting to scratch the surface of understanding that. But in understanding that we are starting to see signals that the objective metrics of what happens during surgery, a much stronger predictors of clinical outcomes than patient factors or disease factors.


Lisa Carmel  10:19  

So clearly, we have the right people on the stage to discuss this topic. So you started to hint at this, Joe about the data, flood of data speaking of the weather, and we have, we have we have a lot of data coming in healthcare, how are these health care systems, the hospitals, the physicians, the nurses, how are they going to manage it all? What's this all coming to? And Atul, I think you also have a point of view, I think we all have a point of view on this.


Joe Smith  10:54  

Yes. So just just putting together a little bit of math, right. So there are, I think 20,000 Plus drugs that the FDA recognizes. There's, I think 6700 medical device categories. There are 190 professional societies that the American Medical Association recognizes giving rise to, I think, a little bit more than 3700 professional society guidelines, each of which has multiple recommendations about diagnostic and therapeutic approaches that one should take to specific patient groups. In addition to that, PubMed produces, I think, 1.3 million new publications every year that are many times relevant to individual clinical states. And their treatment 30% of all data generated today is healthcare data, and it's growing at a compound annual rate of 35%. And so if you put that into context with the fact that we are living through an unprecedented staffing shortage in hospitals, a liquidity challenge for hospitals, 50% of them ran red last year, and an aging population were in 2035, I think we will see the first inversion of the pyramid with people over age 65, outnumbering people under 18, it is unclear how we can expect any clinician to provide best care, when they have to integrate all that information on their own, the bandwidth of the individual does not afford an opportunity to integrate the information they're confronted with to do a decent job. And that's been relevant for a while, you know, just getting guidelines based care in a hospital in the US, you've got a 5050 chance of getting guidelines based care with even simple conditions. And so I think the opportunity for digital and technology in general, is to integrate that information for you and make the decisions as as well they can. And we should not force people to do things that machines can do better. And so I I'm really quite optimistic that we will have the technological kind of backbone to be able to do this. We need some regulatory facility in making sure that can happen. But I'm really quite optimistic that we can close what used to be a no do gap. And now it's a could know don't know, then can't do gap. I think I think there's a real opportunity in front of us. But I would like to see us move there instead of where we are today, which is we make a new gadget. And it signals an alarm to a learned intermediary who, while that regulatory framework makes sense to some, it doesn't clinically operate. I mean, we have we have smart nurses, great doctors turning off those alarms, because they were just overwhelmed.


Atul Butte  13:39  

I don't know how much more I can add to that great statement there. But a couple points. So first of all, we've always had filters, right? I mean, not every doc goes to pathology to see the slide, right, they rely on the report. So we've always had data, going through filters, going through some kind of process, going to let's say, a frontline clinician, that's not going to change, more of that's going to be digital more, that's gonna be AI and machine learning driven computer systems. I want to also echo the fact that, you know, in the early days, let's say four years ago, we were more worried about AI, replacing doctors, whereas that worries still could be there. I think it's turned completely around where we're having trouble recruiting doctors in certain fields. And maybe it's cause effect, right where radiology trainees don't necessarily want to go into chest radiology, because they can see that future coming right. And also, we need the AI because we can't hire enough just radiologists. So it's turned couple of units and it's very important point to realize the narrative has changed there. One more point, though, about AI and of course, departmental chat UBT and all the likes of that. I think there is going to be a big kind of fork in the road here and the fork is whether AI is going to help us with the drudgery of health care or the cognitive part of healthcare. I think we physicians are hoping thinking we Especially that it's going to help us with the drudgery. Can you fill out prior or off forms and these kinds of things you see on Twitter, and what happens when it's the cognitive side. And it's going to be both, of course, that's how these things happen. But boy, it off the shelf tools are pretty amazing as is. So it's a great time.


Josh Makower  15:20  

I mean, I like the I'm gonna share a vision of what I hope healthcare looks like, with digital in the future. It's a four level system. The first level, if you're not feeling well, you open up your, you know, iPhone or Android. And you can you describe your symptoms to a completely autonomous interface, that diagnosis you, and provides you with a certain level of treatments unless they unless it determines that you need to be escalated, and you get that information within seconds, your drug, or what have you, that is needed that you need is triggered automatically from your pharmacy and it it winds up at your house within the next couple of hours. And the majority of interactions that many of us have for well care and are slightly less than well care, including other even sit, you know, conditions like COVID, where you need your pack slova subscription or what have you all instantaneous delivered without a single human ever touching it, That's level one, we're gonna love that it sounds scary, but doctors are going to love it too, because they just don't want that lifestyle. I mean, this is not a good lifestyle, to have to do that all the time. So that layer is going to be taken away by AI and requires regulatory change. But That's level one. Number two is you just don't sort of feel comfortable with what the the bot told you. You want to talk to him and you push another button. And instantaneously someone on telehealth is at, you know, communicating with you. They're sitting somewhere, you know, in Hawaii, and they're giving you their advice. But, but at least you're talking to human now. And now that person similarly, either validates what the Chatbot said, or, you know, further escalates you to the level three area, which is that you go to now actually see someone so, you know, three levels in, you're now going to go into a physician's office. Most people aren't ever want to go, who wants to go shop for things that they could get on Amazon, you know, in the store, we don't do it. It's the same exact mentality. And of course, the last level is a specialist in some sort of operative or procedural thing, which is also way down the road. And you know, to the extent that that becomes more accessible, it's more, it gains access for people who don't have access. So all you need is basically a cell phone, to be able to get the majority of the care that you need, which really is going to you know, improve costs, people are going to be able to get access to care earlier. And their threshold for you know, obtaining care will be lower, but the cost of it will be nominally almost zero, because it's all digital. So that's that's how I see the future. I think it's, I think it requires regulatory change. But I really am, I hope and I believe that that is possible.


Todd Brinton  18:15  

I think we answered the question about cognitive though, right? I think it's gonna go cognitive. Does that mean that that's going cognitive, right? There's decision making, it's going to be process, it's going to be a process, right? It's gonna it's gonna transition from kind of the need for labor reduction to potentially it's true.


Josh Makower  18:31  

But of course, with that computer doing all these things, it's not like, hey, human, would you fill out this form? I mean, that it's also doing the form filling out, but it's so it's taking that part to it starts there. Yeah, right. Right. Go ahead.


Gretchen Purcell Jackson  18:45  

I think my my perspective on this data dilution is very consistent with the vision that you have that sort of layered vision. And I think part of the problem with this notion of the De Luz is that we are taking all the data and the information that we have and dumping it on those those filters that you talked about, and so saying, okay, here you go, physician, you know, here's all this information now, now make a decision. And I think there are two problems with that part of the reason I went to industry was I was a frustrated academic clinician that knew that there was all the information that I needed to make really good decisions was out there yet it wasn't getting to me. And so one of the rules I think we have when we are digital companies are the digital parts of our companies is to take that data, the data that we have and perhaps the insights but even the raw data and deliver it back to the ecosystem, deliver it to all the stakeholders who even may have part ownership of that and allow them to use it. So not to necessarily be the filter. There probably too many filters these days. But to democratize it, and give it in part to you know, of course the clinicians but maybe the payers maybe the patient's themselves? And what?


Atul Butte  20:04  

God forbid.


Gretchen Purcell Jackson  20:05  

God forbid, no. You know, it was it was only it was only yesterday, which, you know, maybe it was a decade or so ago when people were super worried about people, patients and families hurting themselves if they had access to health information, and it's really borne out that they haven't hurt themselves if we can get them. But I think part of the part of our role is actually to democratize that information, not necessarily be be the people who are making the final ruling on it.


Atul Butte  20:38  

If I can quickly respond, as much as I would love to vehemently argue against Josh right now. It's not even the future. I think that some of what he's saying is the present actually, right. So you have Amazon care, or whatever they call it before they've pulled the plug where virtual visit within 60 seconds of opening the app, your virtual first plans. And you know, it's funny, because five or 10 years ago, I think physicians would have argued, how dare you do this without a physical exam. And then with telemedicine, we've done this to ourselves, right, and how much care we deliver with telemedicine. Now, within 60 seconds. I wish that Doc were in Hawaii answering that, but probably they're going to be in a call center merited and measured on how many they're doing per hour. And so that's not a you're painting a pretty picture for the talk here. I don't think it's gonna sell it. Yeah. Okay, so, so but to create this ecosystem, you got to share the data, right? You got to have these systems, but I think they're gonna be wolves and lions, where, you know, health systems, and I'm I guess, representing providers here. And not all providers are gonna want to share data with all participants and ecosystems. But of course, we want to share data with patients. That's a no brainer. And by the way, it's federal law. But we of course, we want to share data with patients. But with payers, I think it's a different story. And I think that we can go into more depth there. But that's going to be kicking and screaming. I think regardless what you believe in transparency, I'll go ahead.


Todd Brinton  22:02  

I think what we're talking about here, though, is a system, right, and not just a technology. And so what Josh is talking about requires a system right to actually be integrated and connected and do able to beta move freely to then ultimate. And we live in a very siloed system, right? We like different healthcare pants fee for service, some are more. So how do you bring that all together is the challenge and that that's going to be a big leap for us to actually bring all this stuff together? I think it's gonna happen. I'm not saying that. The question is, how do we do that? Let me give you another analogy, which is, if you look at where we are right now, the number of things that I see some really brilliant algorithms and technology that are out there really, very insightful. But the first thing I ask myself is, this is great, how we're going to connect it, how am I going to get access to it, how and the things that are most valuable to the organization is coming saying, we're already piped into 130,000 patients or 130 hospitals. Now we have the ability to pull this up together and make decisions. But by the way, if you don't belong that system, you don't get that stuff. So how does that stuff all get connected? is, is that's the way we're going to make that probably the reality?


Atul Butte  23:05  

I want to argue against that slightly, because I think there'll be systems. First of all, let me be completely chaotic evil on statement. So there is no healthcare system, right? We have a whole bunch of two way contracts with each other, that equals healthcare. So right, so there's no real system here. But I think we're gonna have, you know, maybe half a dozen or a dozen healthcare systems in the way that you're describing. I'm the same way we have three airline systems in the United States, right? You might be, you know, diamond medallion on Delta, but you're plebeian on United, right? And, and so why is that, right? Because they have their caterers, they have their tags, they have their lounges. And so, I think we're gonna see a bunch of those because nearest neighbors in our system, right, our competitors, right, we put billboards next to Stanford, they put them next to us at UCSF, and so nearest neighbors in this ecosystem are competitors. But the nearest neighbor of a new you know, the enemy of your enemy is my friend kinda they might not be and I see that kind of hopscotch someday making maybe half a dozen I think Glenn Steele once once taught me, a guy scrub will probably see a dozen of these in United States when it's all rolled up someday.


Joe Smith  24:12  

Yeah, and, and, and just to expand the horizon a little bit, some of this pathology is uniquely US, you know, so, so I'm part of an innovative health initiative out of the EU where there's $2.4 billion euros sorry, they're about the same right now, on the table to talk about how can we effectively share information across silos across sectors across countries so that we can do a better job of understanding health and wellness for the entire European population. I love that idea. I mean, if it harkens back to the talk before us where they were saying, well, the four minute mile was thought to be the peak performance of humans until you realize that you know, you should shoot beyond that. And then This notion of everything is siloed, everything, you know, everybody's densely holding on to their little bit of healthcare information. I think that is unfortunately true derived from, you know, a capitalistic healthcare system that we have in this country that has had many positive outcomes, but some disastrous consequences. And I think we can look to other nations that are doing a better job. And in fact, I think if you look at the 11, OACD countries, every one of them is doing a better job than us in terms of returning value for money. And so I would like to imagine that we don't all have to live with a uniquely American pathology.


Lisa Carmel  25:38  

I'm just wondering if this we could keep going on this this one question this one topic. But the one of the other topics this this is start starting to bleed into, and I think we It would also be a great conversation to have is, the whole idea as you're talking about silos is the decentralization of healthcare hospital at home. And, I mean, let's just open that Pandora's box right now and talk about like, How feasible is that? And in what is that truly going to look like?


Atul Butte  26:11  

I'm gonna take the con side on this side, I think we're gonna take the pros, I know, Joe is doing this. And he wanted to take the pro side on the stage for hospital at home.


Joe Smith  26:19  

Oh, it's so hard. I mean, so. So I do think there's a pro and democratization, decentralization of healthcare, and it speaks to Josh's vision of where healthcare is gonna go that you can get some of it on demand point of concern testing linked immediately to, to therapeutic access. I do think that's true. I mean, so, in full disclosure, I'm leaving here flying to Barcelona for the world hospital at home Congress. And I'm keynoting the first day, there's a little bit of pro. And so it's something that, that we as BD track, because, frankly, you know, of the 45 billion products that we sold into healthcare, we sold most of those in the hospitals. And so, you know, not wanting to miss the Kodak moment. Right. And, and so I think the numbers, though, speak to the size of the the current challenge. I mean, I think, with all of the hype, and all of the dollars that went into hospital at home over the last several years, I think there were 17,000 admissions to hospitals at home in the US last year, compared to the 32 million that got admitted to hospitals. And so if you're not in the finance industry, this is still decimal dust. And so, you know, is it going to be something that some people want right now, the catalyst is the Medicare waiver that has paid hospital level reimbursement for non hospital level care. But I think that is necessarily transient.


Atul Butte  27:47  

I mean, so we have ambulatory at home now, right? Because the telehealth, right, that's certainly there, and we got remote patient monitoring, and those companies will come and go, and there'll be some value at some point for those. But I think we're gonna get reach hospital at home the same way, you know, as long as it'll take to get an oil change at home, right? Yeah, some people change their own oil, but otherwise, or change my brakes at home, right? All that specialized equipment, right? I want to be with Da Vinci robot, right, I don't see that fitting in a in a van. Right. And so I think that's where a whole bunch of things are not going to be able to be done at home the same way the specialized equipment and people are at a mothership at some point, right.


Josh Makower  28:22  

And not only the equipment, but, you know, unfortunately, I've had two elders, who've had to go through very difficult situations before their end of life. I mean, you know, helping someone get up from the bed to be able to do what they need to do and just some money needs, you know, bed sores, turning, you know, I mean, it's just it, you know, the oversight, even without the equipment, just the clinical decision making, you know, in those, you know, last months of your life, it's just hard to do really well and been in the nursing homes are in the hospital, they're just overwhelmed, and they're not getting great care there. And so the drive is, you know, let's, let's get this person home. But it becomes a tremendous burden for the family, and especially for anybody with any caregiver background, like me, you know, become the chief physician in charge, and it's just dominate your life. So it's just hard to imagine how in the decision making part Sure, maybe that could be a little computer on the side, but man, all the physical requirements, and the decision making the very complex decision making is not it's an evolve quickly evolving disease state. It's just hard to imagine how that really, really works in the purest vision of it unless someone's got a very simple issue. You know, a routine infusion that needs to be managed or some something like that you could see but all the other things that are associated with really complex diseases that are sort of in that in that phase. cuz it's hard to imagine how that really happens,


Gretchen Purcell Jackson  30:02  

I actually would like to push back a little bit because I know that my pandemic experience was really, for me, and for a lot of the people around me was a, a return to what I think of some of the core things of focusing on your family and your community and faith. And, and so I think this notion of hospital at home is when you return to that, when you say, I have to take care of my family, I have to take care of the people around me. And that is part of my primary responsibility, that hospital at home really emerges as is a really phenomenal vision. And, and I think we well, I feel a little safe, that we're probably not doing DaVinci surgery at home anytime soon, maybe, maybe not. I know, I don't want to get in trouble either way on that line. But I do think for much of the care that you get in the hospital, we have the technologies to do the monitoring, we have it we have the devices that can do the monitoring, and we have the technology to tell it educate people in home caregivers. And I think a lot of people have gone back to saying, you know, I can actually work from home so I can take care of my aging parents, I can take care of my special needs child, I can actually contribute to my community and take care of the people that I care about around me. And so I think hospital at home, that there's a big future for that.


Todd Brinton  31:30  

Okay, I'm gonna take the opposite side on this one, which is, I think this is the best example potentially of tech push that I've seen for digital, which is, it's possible because digital can do it. But I think we're talking about a completely different fundamental need in hospital care in the critically ill patient, or someone who's chronically ill end of life is a very different problem than ambulatory access to care, preventative care, care when you're acutely sick. And I think that, you know, the idea that one, this idea of what digital is can solve that spectrum. It's incredibly powerful. But I really feel like we're talking about taking the same tool in the same hammer and trying to potentially solve I just think they're totally different providers


Gretchen Purcell Jackson  32:12  

I don't disagree, but I think there's a lot of space between critically ill through and ambulatory care, there's a huge base that people spend in the hospital, they do not need to be there, and they're at risk of getting sick up there.


Atul Butte  32:24  

I'm just gonna say, okay, so I think to be fair, we at UC Irvine, we partner with a company called Dispatch Health where trying to get patients out the door sooner, right, who are otherwise stable, we can monitor them at home. And so critical things done at the hospital, then you pick up maybe more if the family is ready to take on some of that care and all. But I also want to say there is a huge distance also geographically between the home and the hospital. And that is covered by a CVS or Walgreens or Walmart health, Optim. Who knows what Optim is going to do next Dollar General? General now? Yes, Chief Medical? Yeah, exactly. So maybe we're thinking to literally about home home, and there's the community, and there's all these community providers between us and that home to


Todd Brinton  33:07  

It's a spectrum, I mean, totally, totally a spectrum. And I did take the end example. But I think that what digital will be for the ambulatory environment thing else, and what it will be, ultimately, are completely different things. So we're throwing this giant umbrella. But there's the tools may be similar, but they're gonna be applied in very different ways.


Josh Makower  33:25  

Yeah, in fact, I think the doctors are more replaceable than the nurses are. A lot of nurses are actually important because they're the ones are actually and the doctor comes in, I think this and this Nurse, take care of it. You know, the nurse actually has to do all the physical interactions and all these things that, you know, maybe robots


Todd Brinton  33:41  

We saw, I mean, luckily, we saw a pandemic, it wasn't because of shortage of doctors, it was really the shortage of nurses.


Joe Smith  33:46  

Absolutely. No one if I was going to try to close this question, right. So I think the great question that's been asked, is, hey, is caring at home as safe as care in a hospital? And I love the inversion of that question. It's like whoever decided that hospitals were the safest form of health care. I mean, so if, if you were watching, I think the Wall Street Journal picked up a New England Journal of Medicine article by David Bates at the Brigham, and said, you know, there are 35 to 40 adverse events per 100 patients hospitalized. And so I don't think in any system, you would imagine that that's as good as we can be. And so if this dialogue puts a little pressure on hospitals becoming safer, because we're comparing it to the safety of the home, and avoiding the delirium that you get in older people who get too many drugs, no sleep and in a foreign environment, I think it's the opportunity to make hospitals safer is one of the great side effects of this.


Gretchen Purcell Jackson  34:39  

And there's a lot to learn from the Amish in the Mennonite population, who are your patients who come in and push who are willing to pay for whatever care they deem necessary, but they also will push back and say, you know, I don't really need to be in an ICU because I have a community member who is sitting at the bedside of that patient doing the monitoring that that you're paying for it and doing it better.


Lisa Carmel  35:03  

So I think we have time for maybe a rapid round on, on because we can't do a topic without it. We can't We can't discuss digital innovation with without at least going through and hearing from each of you on AI. And the question is, and I know I'm opening another Pandora's box, because I don't know if we can get through this. But but with AI, I think the big question is, Are we there yet? Or where are we on that journey to the evolved AI solutions in med tech? You want to go down?


Josh Makower  35:38  

I'm sure. Let's go quit? Yes, no, I think this is awesome. I know everybody's afraid of it. I think that it's about a, we should be about afraid of it as we are for word processing, you know, it's going to be an integrated thing to everything we do. And it's going to elevate, you know, us as humans to do the things that we do best. And all this stuff that sort of wrote that somewhat differentiates people today will be level playing field. So I think, I think it's a, it's going to be awesome, I love that it's going to be installed into a basic feature of Microsoft Word and everything. So most of your papers written and it's all about you to sort of how to spice it up and make it you. That's great. Why? Why do we have to do all the all the stuff that can be easily done and very well communicated? And let's focus on the incremental piece that we can only do best as humans.


Todd Brinton  36:31  

Incredibly powerful tool. But I would say part of the solution, not the solution. So systems connectivity, democratization of health care, all those things are essential, I think to apply this piece of the solution.


Joe Smith  36:45  

Yeah, I've grown fatigued of the question of will AI replaces clinicians. And instead, I firmly believe that clinicians who use AI will replace those who don't. In in preparation for this talk, I have to give, I asked the generative AIS to draw me a picture of hospital at home and it could and I said, draw me a picture remote monitoring. And it could, I asked to draw a picture of chronic care for you know, of continuous care for chronic disease, and it could, and then I asked him to draw me a picture of electronic empathy. And it couldn't. Right. So I think I think health care has an emphasis on care. And that's given by people, the rest of this stuff is just going to be a helpful tool.


Atul Butte  37:27  

I'm both even more optimistic and more pessimistic at the same time here, because I think I've just been blown away with this off the shelf tools right now, like ChatGBT, and how well they can understand our progress notes, sometimes better than our own oncologist at this point, I think. And that's just GPT 3, we've got four and now we can train it with our notes now. So I think, in some ways, we might be entering an arms race quickly, of who can build out the best models to understand what patients are going through, right, we have all this digital data, right? In our EHRs. And parents want to know providers want to know summarization tools. What would you do next? What would you do next on this patient viewer, Bob Walker, what would you do next on this patient? If you're Sloan Kettering, right? Or what would you do next on this patient? If you were United Health, right. And so I think the same way you can get it to sing a song as a rap singer, right? I mean, you can do all that today. So I think all that's going to happen, is that gonna be useful. Who knows? I love the empathy side of it, no doubt about it. But delet telehealth, again, we keep doing this to ourselves as a physician community. And I think, you know, when you're comfortable, and in fact, desiring of a random doc within 60 seconds, explained to me where the empathy was there. Because I think we're just putting ourselves out of a business here. Yes, I love the empathy side. But it's a $4 trillion market. And I can see people trying to chase and trying to capture some of those dollars. So I think it's, it's here now. And boy, that thing learns faster than any med student can. So


Gretchen Purcell Jackson  38:57  

Excellent. Well, I would agree, I'm optimistic, but I'm just optimistic. That's the way that I am. I worked for IBM Watson Health, and so they have AI solutions for all the stakeholders in the healthcare ecosystem. So there were AI tools that could detect fraud and claims databases and identify targets for drug discovery and provide clinical decision support. So I think we're there there are solutions. I think I would have sort of one caution. And one idea. I think there, As Todd mentioned early in this discussion, there are a lot of tedious tasks in healthcare that need automation, and not all tedious tasks that need automation need AI to do it. So we don't There are a lot of things that we can improve, that don't necessarily need AI. Second, I think one of the biggest concerns of any healthcare executive right now is that staffing in that burnout and they're related and I think one of the best ways that we can use AI is again to potentially put data and insights in the hands of clinicians. To help them do their job better, or help them learn and develop. And what was very striking when I left academic practice and went to industry is there was this new attention to be and my talent development, what do you want to learn? And how do you want to grow? And there is none of that. A busy clinical practice if someone is getting you to see more patients, nor is there they're in an academic practice, even though they pride themselves in training programs, there's not a lot of emphasis once you're in practice of how would you like to learn and grow and improve your skill? So I think we can use some of these AI tools to give people put in their clinical workflows, tools for them to at a small level every day, do a little learning and growth. And there is nothing more invigorating or a better solution for that burnout, then for people to be able to learn and grow.


Lisa Carmel  40:53  

Well said, and I just want to, I think we are right at time here. And I just want to thank everyone for coming and early this morning and I want to on behalf of Veranex. Thank you so much. This is the easiest panel I've ever had to moderate. You're putting me out of a job here. Thank you. Thank you


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