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Behind the Scenes of Digital Health: How Leadership and Introspection Create Innovation
Episode 52229th July 2022 • This Week Health: Conference • This Week in Health IT
00:00:00 00:45:20

Transcripts

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today on This Week Health.

I do think it's a journey and no one has mastered it and that's what the value of the scientific community is to work together. Just being aware of the fact technology alone is not a solution. Just being aware of the fact that we need to combine different kind of sciences together to really get an impact is itself a very big understanding

Thanks for joining us on This Week Health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health 📍 leaders.

All right. Today we're joined by Ashish Atreja. Dr. Ashish, Atreja, CIO and chief digital health officer for UC Davis Health. Ashish welcome to the show. Welcome back to the show.

thank you, bill. Glad to be.

You have the honor of being the only interview I ever completely screwed up. I actually deleted one of the interviews, our first interview that we did together, I deleted and as a professional that's the only time that's ever happened to me. I feel like I should apologize to you every time I have you on this show. It's kind of crazy.

Which was a reason it got automatically deleted. Maybe there were things which were told, which should not have been told. So it's all.

Who knows. Who knows? Well, you, you were well, first of all, you're with UC Davis. So tell us about UC Davis health a little bit.

Yeah. So we are one of the five health systems in the UC system. And one thing which I did not know. Which I actually got to know by the time I was signing, my letter was all the UC system, the UCLA UCSF, UC San Diego, UC Ryan, and UC Davis. We are one legal entity as well as with all the UC schools, schools of engineering, biomedical engineering, computer science, UC Berkeley.

We are all one legal entity. So, so the collective power of UC system is amazing. 10% of all NIH funding, 10% of all research productivity in medical science, 50% of physicians train in California, all come from UC system. So, and it's a public organization. And I think I always wanted to be part of, I've been very fortunate to be part of medical institutions, Cleveland clinic, Mount Sinai.

Where it's health focus of where we are going is the intersection of healthcare with other technologies. Right? So I think one of the things that really attracted was being part of university. So I can interface, we can interface in healthcare, much more meaningful with all other sciences. Social sciences, right?

Humanistic sciences nursing, medical school, computer sciences, engineering, IoT stuff and really build new things together. So UC Davis being one of those five medical centers and one of the universities. Based in Sacramento Debbie area. So it's right where the capital of California is.

We run out from the bay area, so very close to Silicon valley in that regard. And it has number one, agriculture. Univers agriculture college in the country. That's why it's called USC Davis Aggies, a lot of focused on food and medicine. And with me being a gastroenterologist, that's a natural inclination as well.

And the academic center covers a very wide 22 counties in California all the way. If you can look from pass to. From west coast to Utah, there's no other academic center in that whole wide geographical area. And if you look all the way from San Fran to Portland from not to south, there's no other, there's no other academic medical center in that area.

So by default, by nature, this wide area mean renders of perfect for telehealth and digital health and outreach.

Well, I think that's the thing that would surprise people is Sacramento is on the edge of. A, a significant rural population in and across California, even reaching up into Oregon and out across some other states. So you are the academic medical center for a significant. Portion of, of at least geography. Right? So UCLA is UCLA. I mean, it's Los Angeles. Yeah. I mean, your geography and reach is pretty significant. Isn't it?

That is correct. and that's why different organizations build different muscle memories, different things capacity. So because of this outreach not only we are number three in diversity in our medical school. Very significant. In fact, when as meeting our medical students, many of them actually have come from completely dual background when they're the first medical student in the entire community coming to us.

which is. We were awarded in:

the last time we talked, you were Mount Sinai in New York New York Sacramento, very different walk us through the journey to this new role. I mean, what, what did it look like to go from there to there? How did you know, how did you make that decision?

Yeah. So, so first I consider myself extremely fortunate to be in world class organizations and then learn from it and hopefully contribute at some level. So Cleveland clinic started my journey in informatics, where I did my informatics, my GI fellowship, as well as my medical residency and allowed me to learn the structure and the organization of the.

r, I think Sinai was where in:

The real world is a patient world. And all the applications we are focused from a traditional informatics world are all physician applications. Right? So, so yes, we can empower physicians, but as soon as the person and a patient leaves. The physician office. There's nothing to support them at their home.

And with the iPhone, with the iPad coming in, I became a big believer in kind of, we need to build entirely different sets of ecosystem. Very much like what we are building EHR. We need a digital health ecosystem for patients and patient driven, and that journey started. With being in the chief innovation officer role at Mount Sinai and starting the app lab, which was first or second in the country as a collaborative help to, it was like a startup within Mount Sinai, been in a health system to build and test medical apps.

So I've been NIH funded since:

In fact, I just got the patent finally after seven, eight years where Mount Sinai has got now the patent for being the first app prescribing platform where doctors very much like we can prescribe medicines or we can tell surgeries Right from the EHR. Now we can prescribe apps or digital therapeutics or virtual care tools or remote monitoring tool kits.

lth system. We never knew. In:

To one to many care, because the biggest capacity that we lack worldwide in healthcare is not the science of medicine. We know we have medicines right now, which can treat any patients with blood pressure and can have 95 to 97%. Patients' blood pressure being controlled. Within four weeks. And in truly in the actual world, we have only 40, 45% of patients controlled blood pressure.

That's a big gap between 95%, which science can do versus the gap in healthcare delivery. That's why 45% people are controlled. And that gap is because there are not many enough physicians and we only provide care. Traditionally, when a patient is in front of us and now you can extend post COVID. When a patient is in front of us in a virtual screen, but it's still taking the same amount of time for a physician to do it.

So apps and digital therapeutics actually can have the same kind of framework being provided to thousands of patients, kind of creating medical, avatar physician of thought. So, so that role had been very meaningful and relevant at Sinai where I felt the next stage of evolution would have been, is what I call. From innovation to transformation fit journey, you can innovate as a chief innovation officer. We innovated a lot of startups got spin out including the app prescribing platform, which licensed to rx.health. But how do you transform that? Every single patient. That touches your health system gets access to the best technology in that.

So it's not a 500 people or a 50 people pilot, or just siloed in one specialty, every specialty, the access to the latest tools and efficiency gets done. And what got excited me for the UC Davis health role was reporting directly to the CEO, Dr. Lebarsky. Was it brought in not only the chief digital health office and innovation role which I was doing at Sinai, but also the CIO role.

So it's not standalone innovation. And the goal is to innovate and just do a spin out or kind of create IP value. The goal is to do innovation so you can actually do transformation and bring it a core part of the entire it and entire organization structure. Right. So, because I think the, the field has matured digital health in AI and it needs now transformation even more than sometimes innovation.

📍 📍 We'll get back to our show in just a minute, we have a couple of webinars coming up and I don't like webinars. I think they are oversaturated at this point. And I think a lot of them are not all that good. And so that's why I think I'm the perfect person to put together webinars for you. I make sure that we have great topics.

I validate them with CIOs. I make sure we have great guests and I make sure. We actually plan ahead and we actually spend time together before the actual webinar. So it's not just spur of the moment stuff, but we make sure we identify the things that we should talk about in those webinars. And we even collect questions from you ahead of the webinar so that we can make sure to talk about the things that you want to talk about.

So let me tell you a little bit about the two webinars we have coming up. There's a global survey. That we talked about on the today show a thousand cybersecurity professionals found that 30% plan to change professions within two or more years, and cybersecurity threats are growing. And, you know, quite frankly, we need to make sure that we recruit, retain and optimize our staff so that they can be our frontline.

And so the first webinar we're doing is how's your frontline recruit. Retain and optimize your cybersecurity team. And we're gonna talk to experts from Christiana care and Seattle children's and Seuss about their thoughts on this exit of security professionals and what you can do to stay ahead of that.

You can join us August 11th. At, 1:00 PM Eastern time and you can register right on our homepage this week, health.com on the top right hand side, you're gonna have the two upcoming webinars. You go ahead and click on those again. That is August 11th at 1:00 PM Eastern time. The next one, we're going to talk about ransomware, but I've seen a lot of different ransomware, webinars.

I love this one. The topic we came up with is Don. Pay the ransom and rubric is bringing together some great leaders from Thomas Jefferson university in St. Luke's university health system and and rubric themselves. And we're gonna discuss solutions around protecting all of your healthcare data, especially as you're moving to the cloud.

And specifically, we're also gonna talk about epic. Backup in Azure. And what rubric gets doing around that, that webinar is going to be on Thursday, August 18th at 1:00 PM. You can register for both of them. Just go to our homepage this week, health.com upper right hand corner. You're gonna see both of the graphics for those click on the one you wanna attend, fill out the form. And we will see you then now back to our show. 📍

📍

So, let me ask you this. The, when we talk about this, you've got me completely off my game, which is great. I appreciate that because you got my mind going one, we're talking about scaling healthcare essentially is what we're talking about here. And we're trying to create that, that personal relationship with a multitude of people in our communities, a constant ongoing relationship from the health system and the care providers to just a massive people. So a lot of times people use this analogy and and actually I think it's appropriate. Our car has all these sensors. It's reporting back.

Somebody's looking at those sensors. They'll know if there's an anomaly. They'll tell us, Hey, you. Do something it's an ongoing relationship and it, and it's passive for the most part. I don't really recognize that my car has that relationship, but when it needs that relationship, I'm glad it's there. I think a lot of people from the patient side are looking for that kind of relationship with a trusted healthcare provider, like UC Davis, they're saying.

I want more. You want more touchpoints? I want more touchpoints. I want you to know do I have a breathing irregularity? Do I have blood pressure issues? I want you to be looking at that. But what I have found is we need other technologies, cuz if you just throw all that information in front of a single physician, that you, you creator that physician.

So what technologies are gonna step in there to help us to be able to scale that and create those personal relationships.

Yeah, and I think technologies have become ubiquitous. And and I think the things you are touching upon we call it remote monitoring technologies. And the things that we did trial at Mount Sinai. We prescribed an app with remote monitoring devices, Bluetooth connected devices for heart failure patients and showed 40% of emission reduction. And this is five years ago, but that has now advanced that you can combine those device based technologies for monitoring. With what we call is device list monitoring, which is this text messaging or a nudge from a phone or from an email to see how they're doing symptom wise, we call it EPRs electronic patient reported outcomes.

And the whole logic is built on that. So if a person answers something, that's. Variation of before it automatically gets alerted. So you can combine all these also digital programs. I call it Lavango like programs. You can now create those programs. And we created around 15 or 20 of the programs by the time I left at Sinai.

Now we are trying to do across every specialty at UC Davis. So not only the patients get monitored, which can happen with devices. The flip side of that is, well, we had patients like in other examples, Who were uncontrolled if we don't have the capacity and they were still having uncontrolled blood pressure being reported for six months and no one is acting on it and their behavior is not getting modified.

Right. So you combine those technology of device, less monitoring with also work because a digital navigation or digital front door. So they learn about it. What to do different as well. And, and then if you have those technology layers, right, I'm not gonna say some proprietary names or something of that nature.

But then you have a business model which is now RPM codes. And now beyond RPM codes, now we are remote therapeutic monitoring codes to do device list monitoring. So now not only you can actually bring on this technology in a very mature manner with EHR to masses, but you can actually. Get compensation for the efforts and the compensation can be so structured the way it is that you can establish a whole team of remote monitoring team.

What we call is a digital navigators now, so the doctors can do their job and they manage critical things, but this passive data that's coming, sometimes they to be actively handled. You have a central team that's handling that, then bubbling up to the right physicians for the right decision making.

Then we have been now able to scale. What we call is enterprise wide and it's not then dependent. Momentum of inertia, our sponsorship of one physician or one chair over one specialty. It is not embedded across specialty as a key operation, kind of a division role.

Yeah. You, you take us down this road of I think the category that people are talking about is asynchronous health, right? So it's our asynchronous healthcare. So. A lot of it doesn't need to be real time. Doesn't need to be me and you talking or you and me seeing each other. It could just be an inquiry about, yep. Hey, I have this or reporting in, Hey, I got up today. I feel a lot better. What, whatever, but usually it's a prompt from the health system.

And we have found that unbelievable texting is still the best mechanism for getting feedback from patients. And so this asynchronous model becomes an interesting way to scale, but you took us in a direction and I'm just gonna keep going there, which is behavioral change. Right? Yeah. I remember I, I was having conversations with doctors when I was at St. Joe's and we were, we were talking about things and one of the, one of the doctors was. Talk to me, I'm like, what do we really need to do to move the needle? And he. Bill at the end of the day, we have to do behavioral change. Cuz the behaviors of the us population is just horrible. And actually that started us on a road of exploring what does it take to change people's behaviors?

And we were looking at at prompts and those kind of things. Have you guys explored how to really move a population from a behavioral health or not behavioral health from a behavioral standpoint in terms of health activities?

Yeah. And I'll share the journey. I do think it's a journey and no one has mastered it and that's, that's what the, the value of the scientific community is to work together in that.

Just being aware of that gap is a very big thing. Just being aware of the fact technology alone is not a solution. Just being aware of the fact that we need to combine different kind of sciences together to really get an impact is itself a very big understanding? First of all, I like to second completely, I believe text. Is the most dominant, engaging strategy today that exists and the biggest to bring on digital bridge from a digital divide. So you can have an app, but the first part easiest to start is a text. Right. So, so we had a lot of success in that. In fact, we actually embedded a whole text layer of building technologies.

So most of the things that got prescribed actually came as a text in the first we launched during COVID in the middle in New York city. When the pandemic was really at its worst. We had, we got so many calls of patients. We did not have enough bodies to take the phone calls. We then recruited medical students from Mount Sinai, and we ran to the medical students.

We still were getting more calls. We then launched a bot, which we prescribed through the EHR to 1 million patients. But the bot, even though it was based on Microsoft Azure bot technology, the engagement for the bot started with a text engine. To the patient, this thing we care about, we want to give you, and we behalf of Mount Sinai, the most accurate information for COVID click here to begin, and there's a deep link.

Then we could launch a bar experience, a complete web experience, a complete app experience, and 55,000 people automatically decided to passively monitor themselves. Over eight weeks without a single in person coordinator.

and if you had waited for them to come into the portal into MyChart or whatever you were using at Mount Sinai, that that open rate is a lot lower than text. The text open rate has to be just astronomical compared to that.

Absolutely. And it is proactive. It is reaching to them. Right. And you can create a number of experiences infinitesimal experience. Using that a beep link, you can bring any app. You can bring any bot. You can bring any text message conversation.

It's just imagination. So now when you have that tool kit with you of completely infinitesimal design thinking possibility, now you can bring that layer of behavior modification to it, because now you're not constrained by a model of one portal where only this thing gets showed you are bubbling up the most important thing.

You want the person to take action right there, right? Yep. So you can get the patient recorded the next best. So, so I did my master's in public health and it was in health, behavioral modification and a master's thesis was medication adherence. And at that time we did not have digital technology. So I lacked the tools.

So we created a framework called simple framework for adherence, but now we have the digital health tools to actually implement that framework. So in a way, if, if we look at that model's previous models of health, behavioral, Very well validated models across different diseases. There's a very proven model called health belief model, which means I need to believe in it that I'm at risk.

And what I'm gonna do is gonna really benefit me right now. But once I know those, for example, many people that smoking know that they're at risk. They may not understand the magnitude of that. So you can explain them and they may understand the benefit if they quit sometimes. And we explain them. The third important thing is self-efficacy.

That they should believe that they can do it. And that is like for weight loss. Right. I know weight loss is good for me. For example, I'm overweight and I know it's gonna be beneficial for me. The side effects are less, but I may not feel competent enough that I have the things to me to actually be able to do that.

But if you combine those health belief domains, which start with knowledge first, because if you lack knowledge, you're not gonna have those right beliefs. So, so then you segment the population in terms of persona. For any population health program into people that first need to empower them with the right knowledge and the knowledge, then you believe led them to create new, better beliefs based on scientific knowledge, both on risk.

So they act on it and the benefit. And then you give them empowering tools in that sequence. Right? So, so you take that structure of the model and then you embed into a digital health program, which means if you have to do for blood pressure, you start off being in a digital monitoring program. You create a program which engages them to text message on behalf of the cardiologist or primary.

Care doctor tells them how much risk they are to the blood pressure is uncontrolled for stroke and others, and how much benefit they get. If they get the right medicines, they get the knowledge. Then you walk them. It's so easy to monitor it by just a blood pressure monitor. And actually you prescribe a blood pressure monitor with a 4g kit that reaches their home and they plug into the power outlet.

They don't even need to use an app. They just use any device, weight or blood pressure. The data comes back right there with alert to their text message and with alert to the physician office. So you build their self-efficacy and then the, the last thing is, is kind of for nudges. So once they do it once, then you get the right feedback from the clinical team.

That, Hey, glad you noticed that. Glad you did that. And I'm so glad to see you're getting better or you need an action, then that reinforcement happens. Otherwise it dies that behavior. So, and then you can do it for any specialty. Once you have this tool kit and you can actually embed these principles into it,

It was fascinating when we went down this road, as I St Joe's, it was, interesting because the amount of study that has gone into this is just staggering. And the, when you talked about personas, and I think when people hear personas, they think of that marketing thing where they come in and give you here's the 15 personas, but the psychographic profiles are. Limitless, it's unbelievable.

All the different variables they pull together and they say this person is likely to react to a text message in this way. Use this, this kind of verbiage, use these kind of words. I mean, there's so much study detailed study and analysis. That's gone in to how to change behavior.

But still the us is one of the most obese just all the bad things about healthcare. We say Hey, our healthcare, system's one of the worst in the world. Well, it's because our health population is one of the least healthy in the world. We're not a walking population.

We're not a exercise population. Well, you're in California now. I I'm sure you know that in California. Different deal. You're you? I had a gym membership when I was in California, so

I'm certainly more outdoors. My vitamin D level has increased automatically, which has never in my life. Increase I'm at the best weight so far in the last 15 years. It's partly, I think California, but partly I think I'm so blessed with the culture here. There's a value of work life balance as well. And there's a trust in the community. So you're not just trying crazy. You are in the right direction and you also understand the more you take care of you and your family, the more you can actually be in the right direction.

But I want to close the loop on your stuff. Nu center did one thing in new pan a great center. They just changed one word bill, and that had a big impact on the number of people taking vaccinations. So they changed the language from, Hey, we recommend vaccines come over and take it. Something like that to, we have reserved the vaccine for you.

Please click here to avail this opportunity. Yeah, just that word. Difference. And so we created a bot here. We have a trust bot framework to bring one to many care. We, we were able to use the same kind of principles, design thing, carefully chosen words. For the booster, which most of the people had already got boosters of people who did not get booster for resistant population.

We were able to reach with 30,000 people who did not have the booster, a thousand people. We got converted automatically without a single coordinator using one to man care, using those principles. So it's, so that, that brings to in our traditional it shop, we don't have design thinking people. Right, right.

We don't have people who look at words and impact of every single words. So we have to create organizational entities to build those capacities, to have those interdisciplinary team of people to be more impactful.

But you we need at the table, we need mad men at the table. We need that the old mad men show with the guys who created commercials and they got everybody in the world to smoke. I mean, but they understood behavioral change. They understood the power of words. They understand the context and use of imagery. I mean that whole marketing and advertising world probably has studied behavioral change more than anybody else and has been effective at it.

And to be honest with you, wouldn't be too bad for us to sort of tap into. More and say, all right, let's figure out how to how to get people. They, they come out with got milk and all of a sudden the milk sales goes goes way up and you're like Absolut, seriously, two words and an ad campaign. Got it to go there.

Can you believe it?

It is unbelievable.

We have made healthcare boring and by us, by saying, we mean, is. There's so much we study in our medical school, right. What we don't study is communication and behavioral science impact. Cause we just don't have time to studying everything else. Right. But the visual part would be either we build partnership. So I, I just became a fellow in our graduate school of management. So kind of now bringing management and marketing principles to us because what's the value in having technology and having a program. If our success rate is 20% of outpatient adoption, right.

Whereas having a portal How can we first close the loop with the portal, get to advanced portals but can we get in an honest fashion and the right kind of messaging to actually really get to 95% adoption? Right. So there is an increasing understanding. I think sometimes what happens. I, what I'm realizing is you have to solve one set of problems to have your horizon being expanded. To now know, now we need to go into disciplinary. I felt we need to go through the COVID part to learn the value of virtual care and digital health and that, Hey technology, we can seamlessly integrate. Now we can say, Hey, now we can seamlessly integrate technology. How can we make it most impactful across the board?

So now we can put our efforts more on. We don't know, this is possible to do This is possible. Let's now work on embedding behavioral science, marketing, science, and other things to make it much more impactful.

So you made the move from Mount Sinai, New York city, and you can't see rural anywhere from where Mount Sinai is. I mean, you'd have to, you'd have to drive pretty far out of the city if you had a car. I mean that, I mean, it's, it's in the heart of the city. Now you're, you're in this place and you may not have had enough time to really make this transition, but rural healthcare is. Some would say it's in crisis right now.

We came through the pandemic. We don't have enough providers out in those locations. They're not funded well enough, you have access issues. Even some of the technology doesn't reach out there as well as it could. Have you gotten a chance to really delve into rural healthcare yet? Or is that an area you're exploring at this point?

Oh, very much so. I would say. Nowhere, I'm an expert. But we have great champions here. Who've been doing rural health and engaging for many years. So I've been able to build partnerships and actually do initiatives with them. so geo from UC Davis health has been a champion and in fact, he had a big program where he already had grant funded to actually impact rural healthcare in migrant farm workers. And we just caught a earmark on digital health equity. We got 1.7 million to actually. Expand framework of our express care and realtime virtual care and subspecialty access to federally qualified health centers and to community hospitals in rural California.

So they are able to get access to subspecialists, which they may not have or access to express care if they don't have their own primary care doctor in that regard. So a lot of the stuff we have built during COVID usually. For us. And we have express care where we can bring on a physician within five minutes from emergency medicine and now expand to family care we've been providing for our own population.

Now we are saying how we kind of partner with federally qualified health centers and with other. Community hospitals. We have a big partnership Adventist health in the community as well to actually create a common technology layer and solve that access issue. Now, some of the issues like insurance gaps in others are solved through grant or some funding.

We cannot have that macro impact just from that, but access issue we've started taking stab at that and addressing that. The other part which has been helping is learning from our medical student. Many of us who actually come from the communities. And many of them actually go back to the community and being trained here, we develop a kind of a network effect with them and they provide a guiding force on how to be a great turn about the needs of the community.

I still believe it's a, it's a journey. I do believe COVID helped a lot. Because if you are a physician trained in UC Davis, for example, you can serve. Anywhere across California in telemedicine. Right? Right. So this access capacity, wherever that exists we are now doing at UC Davis, but I think the real thing would be we also work with California Medicare foundation and California public health foundation.

So if we can create a network effect. And that's what we are hoping is we do at UC Davis, but then we bring other uses together. Other UCS are doing it. They bring us together. At least we have five health systems in different areas of California with speciality access being part of the same network. And then we even open it up completely. So FQs and community health systems and you start kind of solving more challenges that way.

Yeah, it's we did a telestroke program with some of our more rural locations. It was really effective. It was there, there are situations where every minute really counts and getting access to the specialists is is so important. Let me, so what direction do I wanna go here? We have about a couple minutes left. We have about five or six minutes left. What are some of the top challenges facing healthcare in your geography right now?

So we went through clinical strategy planning, which came with tomorrow's healthcare today, and we have put digital Davis as a catalyst for that. So from my side, what's been task to me is to help make. UC Davis can work with other uses to help help systems become digital and data for organization. But a big part of that, one of the, one of the bigger challenges that has come to us is our limited capacity for hospitalization, our beds on I 7% four, we don't have any capacity if any peak pandemic comes or anything comes. So one of the biggest strategic initiatives we are doing is what we call a scale at. I would say it's an extension of hospital home and much more bigger. It's not just take hospitalized patients and just bring that there it's actually bridge the gap between exactly bill. Like you mentioned, remote monitoring device, less and device monitoring with behavioral modification with ed to home.

With hospital to home. Right? So according across ambulatory nursing home acute care post-acute care all, but under a common technology fabric. So we have a digital Davis platform where we all cloud linked with loud uh, link with, eh, Where we have launched digital front door with bots, the example I gave for the COVID tooth bot and then digital navigation and digital monitoring.

We're bringing actually this quarter. And then next year we started building all AI algorithms under a common AI platform as well. So there's a data layer, which has AI go. Maturity level to scale and ingest and actually validate. And then we have the digital layer for engagement. Digital front door does transactional layers, transaction things like appointment making nudges and those and digital navigation and digital monitoring does more continuity of care and chronic disease management and transitions in that kind of a stuff.

So these are three, I would say technology stacks but the goal is really to decompress the hospital. To be able to, we are not able to handle 60 17 new patients who want to get admitted to us every day because of our lack of capacity. And the new hospital we are building new California tower take five, six years.

So one of the very interesting thing that has happened within that bill is we have started positioning it as a cost center to a revenue generating center. Right. So if we create this virtual or this bed at home, basically virtual and all the digital technologies. We are able to provide care. Suddenly we are actually enhancing the revenue of the hospital through this.

So our positioning is mostly, we call it open innovation, working with other health systems and health plans, but also open innovation working with chief medical officer chief operating officer chief strategy officer internally to actually. We become one. It is not a separate entity. Do this as a call center.

We are actually creating a revenue generation opportunity for the entire hospital. So my four year five year vision, which is now four year considering it's been one year here is to actually convert our entire budget to our revenue generation budget. So people and, and it becomes the most strategic people started looking at it very strategically. As creating. Changing the bottom line of an organization, not as something that cost is going right.

No, that makes perfect sense. It's interesting when you say that, because when innovators go after something, they essentially look at it and say, okay, here's what we're going to do. UC Davis, we're gonna be able to see 10 times the number of patients we're seeing today.

And we're gonna increase our capacity for beds by 10 times in the next five years. And everyone in the room goes, oh, you're insane. There's no way to do that. We can't build fast enough. And you can't. I had to build buildings in California. I understand what that, what that entails to build those buildings in California.

And so you essentially have to think differently. And that's what that is essentially. You're saying, look What level of acuity can we provide in the home? What kind of tools do we need in the home? We just increased our bed capacity by whatever number of beds are in the community, because we can deliver care where they live and where they're at.

And so you increase the capacity almost overnight, then you have to increase the capacity of the care providers. And that's, that's a little more challenging, but you know, you're an academic medical center. You're making new doctors and hopefully I, I would think. As we move forward, changing the way we train doctors and how they think and how they're going to practice moving forward.

And it's gonna be a mix. I would think, I don't know, digital, I I'm leaving the interviewer person and I'm sort of postulating here cause I love these conversations with you, but our, our training has to change in the medical school as well for how they're going to practice medicine going forward. I it's, it's really fascinating.

let me close with two goofy questions. who do you think is the Elon Musk of healthcare?

That's that's such a great question. I never thought of it before. I can't go, I can't think of one person like either in us or globally. I do think there are very big influencers. I would say, like, if we look at digital health, I would sayable is, is one of those influencer thinkers, which has influenced a lot of the thinking and led us to the right place. But I think it's a good thing that is no one person first. All of us, or many of us can be leaders in redefining different aspects of what we can do better.

And then there's a collective wisdom that becomes science. We do not want a thing as precious as healthcare to nothing against Elon Musk, by any chance, it's just individual to have a one individual bias. For science to be there. It has to be adopted mainstream and trusted and societies have to play a role there.

So I think it's, so we need to go from a bias of one to actually the wisdom of Manny. And I think that's, that's actually, I think an asset and they can be many Elon Musks, like or many inferences, like Eric Topo in different spheres to lead. Through many of the challenges we have to do for us healthcare system.

From a laboratory standpoint, how our system is completely broken from insurance to others, things the divide we have disparities, we have the focus more on commercialization rather than mainstream. Difference. And lack of primary care access, I think there's, and we need leaders in all of that in that regard.

I love that answer I think it's a great answer. And to be honest with you, I was come up with the question. I can't come up with the answer. I mean, there's. There's people who have moved the needle in terms of our thinking. And you mentioned Livongo before, seriously.

I mean, Glen Toman has yeah, rethought the way we do diabetic care. And I think that's phenomenal. Now we're starting to see the cost of insulin, go down, become more of a generic than we see that innovation in certain areas But it's not to the same extent Elon Musk essentially made space travel commercial, right?

I mean, that's unheard of. And he started, he made electric cars. Cool. I mean, it's like everybody before. I don't know if you're, do you remember? I remember the first electric car I saw it looked like an AMC pacer. Do you remember the AMC pacer? It looked like an AMC pacer with a bunch of batteries in it.

I know. Never got adoption. And what is most interesting? Is Elon Musk did not start Tesla. Yeah. Tesla was already started. He bought Tesla and I think that's also, I would say that's transformation part. He played, he could spot those innovation. He could see the value he doubled down on it, put all his money, which he got from PayPal into that.

And grew tests that to where it is. The Tesla would not have grown. It never have been made a difference. It could have become another of those cars. So there's a lesson to be learned. It's not just innovation. It's a lot of it is transformation and scaling things as well and taking to the next level.

And many important lessons to learn is actually my role model in many aspects. And also the fact that one person can do it. Can change the direction is empowering for everyone of us. I tell that story to my kids. Yeah. Right. In fact, today morning I had a discussion. They were saying, daddy, oh, there's a company that get started. I said, see, someone started Amazon. Someone started Tesla, you can start something yourself. This is all human beings. Right. And just tell you the story of a one person can do all that is such meaningful and relevant and empowering for our generations, right?

Yep. Absolutely. Well, I expect someday, I'm gonna be able to say. I knew the Elon Musk of healthcare. It's Aishia and here's the interview where we talked about it. Hey Ashish, I wanna thank you for your time. I know how busy you are, and I really appreciate you taking the time to stop in and share your wisdom and experience with the community. Thank you very much.

Thank you so much, bill. Always a pleasure talking to you.

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