Month: March 2018

Outcomes Rocket Podcast - Tina Joros

A Must Learn Philosphy This Savvy Tech Entrepreneur Used to Pave The Way At AllScripts Developer Program with Tina Joros, General Manager, Open Business Unit & Vice President at Allscripts

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Outcomes Rocket listeners welcome back once again to the Outcomes Rocket where we chat with today's most successful and inspiring healthcare leaders. I really want to thank you for tuning in and I invite you to go to So let us know what you thought about today's episode. I want to introduce our outstanding guest. Her name is Tina Joros. She is the general manager open business unit and vice president at allscripts the open business unit. All Scripps is responsible for supporting developers using their API eyes for connectivity with all scripts solutions. They support fire and enable APIs along with proprietary API is built and supported by scripts and have enabled billions of data shares using their API alone over just the past few years. They're really moving and shaking transforming health care with connectivity and improving outcomes and that's why we wanted to have Tina. So, Tina welcome to the podcast and maybe you could fill in the gaps there in the intro.

Tina Joros: [00:01:21] Thanks, Saul. It's a pleasure to be here and I appreciate you asking us to come here and talk a little bit about the program and what we're doing. Just a couple of things to add. Full disclosure I'm a licensed attorney so it definitely helps with the regulatory issues but I do like to mention that just in case anyone is wondering where some of the legal background comes from. So just adding that.

Saul Marquez: [00:01:40] No. Absolutely it's a beautiful skill and over in Indiana right.

Tina Joros: [00:01:45] I originally went to Indiana University for undergrad and law school and now I'm in South Florida so I know you spent a little time in South Florida as well. So I'm happy to be here.

Saul Marquez: [00:01:56] It's so nice over there. Did you escape the hurricane madness.

Tina Joros: [00:02:01] We did alright. We did alright. Not too bad this season. So every year we get a little bit of a scare and we make it through. So.

Saul Marquez: [00:02:09] Awesome. I'm glad to hear you guys made it without any major issues so an hour here so Tina tell me a little bit about what got you into health care.

Tina Joros: [00:02:18] Sure. So in terms of the medical sector in 2000 2002 I was still practicing in private practice as an attorney and looking for in-house work. So when you're looking for that kind of transition into private or into the corporate world you're looking for businesses that are growing and there was no better time for growth for electronic health records vendors than in the early 2000s. That was before meaningful use. So it was just a software development company that had roadmaps and enhancements based on customer requests and everyone was in the mode of you know who can build it faster. Full functionality get something to market. So at that time they were looking for more attorneys and I got my chance and couldn't be happier with how that worked out. But you know this is still a growth sector although I think in a little different way. But for our vendors I feel like I've been in this industry since before regulatory requirements dictated our our futures. And now throughout this entire transition. So.

Saul Marquez: [00:03:20] Yeah that's pretty cool. So your specialty took you into this industry you got in before it started booming and and here you are still so committed to the cause. What do you think Tina after all these years of being in it is a hot topic should be on every medical leaders agenda.

Tina Joros: [00:03:37] Well for me my hot topic is always about interoperability connectivity open platforms. It is all that we think about in the developer program and the open business unit that I run. So for me my hot topic is always interoperability.

Saul Marquez: [00:03:51] You know. And how do we do that Tina just feels like it's just such a challenge to all align on common language or platform like how do you approach it at all scripts. How do you get to that end goal and what do you recommend to the listeners to get there.

Tina Joros: [00:04:09] Yeah I think there's two ways that we think about approaching interoperability. There are the things that we can wholly control within all scripts connectivity and interoperability in and out of our own systems which I can tell you how how we've built that kind of functionality which is very different from the other type of interoperability that we're talking about today which is industry wide. How do we all start speaking the same language. And I think there are very different methods for impacting success and progress in that field. So inside all scripts I think the best way to get started is just to start our API have grown organically based on client need partner requests. We didn't start off with a roadmap that said to be interoperable we need to be doing these 200 things started with a very simple Hi I'm a device integrator and I need to get this resolved over into the patient record. Okay let's build an API that does that and over the years we've taken these requests from our developers and from our clients and we've built out a very robust set of API. I think at last count over 900 different actions across four different solutions and three and API sets. So you know when you're controlling all of the environment and you're working with your own solutions I think the best thing to do is just to get started and to keep building and enhancing and growing on top of that which is what we've done with our proprietary API. But over the last couple of years the focus has shifted and a very exciting way to looking outside of what you can control and thinking about interoperability from an industry wide standpoint and that is also very exciting but comes with its own set of challenges and own kind of dialogue and decision making process. So you know I can talk about all the different ways that we participate in industry wide events to kind of influence the standards that are being set to have her voice heard. But it is a very different process because for interoperability at an industry wide scale you also need consensus and collaboration and agreement on definitions and things in order to move forward. You can't just plow ahead and start building.

Saul Marquez: [00:06:17] That's for sure and it's a balanced approach. And listeners as we listen to this topic maybe you find yourself going to another conference where they're talking about interoperability again and maybe some of you guys and gals roll your eyes and think oh here we go again. But think big with Tina's doing here is thinking about interoperability from a company perspective and what they're doing. And then more broadly. But you've got to start working on it. So Tina maybe you could give us an example of how all scrips has improved outcomes by taking steps toward making things more interoperable.

Tina Joros: [00:06:50] Yeah and I think improving outcomes means something different whether youre a hospital health system or provider. So the outcomes are different based on the solutions that our clients are using and the goals that they have with implementing that solution to begin with. But for me one of the metrics that we use to measure progress is just data shares and that is based on our proprietary API. How many times is that being used. You know every single day every single week to get data where it needs to go and we count data shares weve been counting since 2013 the data shares that were enabling through our program. And to me the best outcome is that those numbers keep going up they keep increasing. For example in October of 2017 we had a hundred and eleven million data shares in one month which is one month's worth of data. But you compare that to an entire year's worth of data in 2013 which was 122 million data shares the very first year we started counting. And you think about the progress in a relatively short period of time. We're now doing in five weeks what it used to take us a whole year to accomplish in terms of exchanging data and the numbers are just exponentially growing. So that makes me happy. That tells me that our API is being used that clients are using the partner solutions we're enabling and building their own things and they're seeing value out of it. If they were not seeing value if they were not getting the outcomes that they want when they connect these things then we would see those numbers go down or stay stagnant and they're growing and growing and that is to me fantastic so there's tons of individual metrics and things we can look at. But to me data shares is one of those that we should all be looking at to decide if interoperability is really happening and if it's really working.

Saul Marquez: [00:08:40] And that's a great call out Tina and so how would you define data share.

Tina Joros: [00:08:44] So for us again with our proprietary API we're talking about either a call that allows someone to get data out of our system whether it's a big call like a get the CDA or whether it's a very discrete call like get med's we can count every single time one of those transactions is happening. Same thing with putting data back into the system. So most of our API are by directional so have we read information from the system through the API that someone didn't have before. Are we putting data back into what we consider the source of truth in the electronic health record associated with that patient. Either way an exchange of information is happening that helps improve healthcare.

Saul Marquez: [00:09:24] Yeah totally. Thank you for that definition. I think that will help a lot. And congratulations to you and your team. It just sounds like you guys are rocking and rolling over there with these data shares going through the roof.

Tina Joros: [00:09:36] Well it's true and our technical teams have done a great job of building a great platform. But I'm going to say for a moment that the technology is not the only answer so for us what we've realized over the years is that the technology working is great. That's one thing but all the business side processes and the things that have to happen in order for those transactions to even take place is something that we focus on all day every day to make sure that the companies that want to use our API both have access to them and that the pricing and distribution model is right so that they can actually get them out into the clients hands.

Saul Marquez: [00:10:12] And Tina a lot certainly goes into that and you said something that really struck a chord is like aims are different for everybody and for you all it's those data shares for clinicians it's improving those outcomes for payers it's something different for employers. It's something completely different so be clear on your outcomes. Friends and you will be able to achieve them much easier. Just like Tina and her team has gotten together as an organization to achieve theirs. You know it's not always been rainbows and Sunshine's. There's been some difficulties maybe you could shine some light on a setback that you guys had and what you learned from it.

Tina Joros: [00:10:48] Absolutely. So in terms of setbacks again on the business side which is where I focus this is where I dive into when you're getting a program started. You start with where you can start. You start somewhere and then take a look at what's working and you take a look at what's not working. After about five years of running the program we had the opportunity to take a look back at all the companies who had expressed interest in joining the developer program and how many of them were actually translating into full partners that had solutions available for our clients. And looking back at that data I was fairly disappointed to see that we were only signing about 9 percent of the companies that wanted to work with us that had taken time to fill out a form and say all scripts I want to be a part of this. There are various reasons for that. In some cases people were just kind of exploring so they weren't really ready to sign up. In other cases we might have applied our own internal analysis and said This is not a good fit for our partnership program and in other cases we had said yes this is a good fit but the company that we approved said no not for me. So we started digging into why why we were not having a higher rate of success with companies that had expressed interest in working with us and that got us into the legal contract that got us into the pricing that it got us into the marketing opportunities that we were offering and guaranteeing in our contracts. And so it took us about 14 months to really unravel what was most important in some of these areas. But to me that analysis was amazing and it helped us produce an opportunity to change our program and to make it even better and more accessible and priced at a different in a different way. So in January of 2017 we rolled out what we call ATP evolution which of course is an evolution of what we had been doing before but taking all those lessons learned and some of the painful lessons and saying okay let's push forward into some new territory and do this a little differently. And one of the things we introduced were some click through legal agreements which as an attorney I am so super proud of the mistake this agreement that goes through this old school email of yes you've been approved here's a PTF version of it and someone says oh I want to make red lines. Can I have a word version and then you go back and forth and you talk. And that brings us back in take weeks that can take months to me. All too slow. I took all of the information we were getting. Where were people redlining our agreement. Where were we having discussions that were just terms that were not a good fit for these developers. And how can we make a contract that is so fair that people can feel comfortable clicking through it. And to me the work we did to get to a clickthrough agreement for our ADP evolution and our new integrator category is a big success. We've had 225 companies sign up in the first 10 months of the program and that is with a boom agreement which is super. So to me that's a big win. It is actually huge. Changing that dynamic and saying okay we don't have to do this old school partnership model anymore we can figure out these terms and make them fair and protective of all scripts and and good for the company signing up. So that's one area we looked at. Yeah. The other area that we really focused on was pricing. So back in 2010 2011 when we were starting our program the only types of developer program models we had were the apple and you know the Google markets with a revenue share percentage and that was a good starting place. But today we actually have taken a look at all of our API has organized them into different tiers and now we charge a usage based pricing for API usage. So we have taken all the upfront cost out of connecting with us and we have pushed that all to just charging companies and clients for what they use based on how they design their integration they can control the costs in large part. So to me the legal side of it the pricing side of it that's huge to opening up opportunities for companies to actually work with us in a way that makes sense with their own business models.

Saul Marquez: [00:14:46] Wow Tina that's super interesting and congratulations.

Tina Joros: [00:14:50] That's exciting. It's exciting when finance could be so exciting right. You our game changers right now. It's really amazing.

Saul Marquez: [00:14:58] That is so interesting you know and health care where you know the fax machine is still alive and pagers as innovators. It's our job to make the process easier to implement. And what Tina and her team have done here listeners is they've made it easier to implement. They took what was hard and time consuming with red lines and they just made it a clickthrough agreement. They figured out what it was that was making these companies tick and made the pricing a better model they made it easier to implement. And in healthcare innovation is implementation and Tina. I just want to say you guys are doing an amazing job at it.

Tina Joros: [00:15:38] Thank you. Well we have a long way to go because there's so many areas of friction in this whole process. And my goal is to eliminate that friction to streamline every process that we can so that we can get to the point where these apps and devices can be connected in a very a very enjoyable way. Not even. Let's not make it not not about making it less painful it's about making it enjoyable. Hey I got a new app today and we're starting to use it and it's fantastic. So to us that's a pretty high bar. But I think it's achievable.

Saul Marquez: [00:16:10] Love it. And you guys have the vision and you're cranking out the numbers. Tina I think it's wonderful. And at the end of it all it's being able to make these applications in such a way that enable our providers to give patients the best. And I think that's super cool. What would you say. One of your most proud moments to date.

Tina Joros: [00:16:32] I have a lot of proud moments. I was really happy with that big October that we had in terms of data shares. I'm always happy when the companies we're working with win awards and when a client walk up to me at an event and say I have found out about this the scripts application store and we installed it and we're using it and it was a great experience. I'm happy when people are pleasantly surprised. So my proudest moments are a series of small moments that add up to really changing the way we do things. For the most part so we've got a great team. We've got great clients we've got great companies working with us. And honestly those little moments we try to take the time to appreciate the fact that an application got installed is working people are getting value out of it. That in and of itself is winning in this industry.

Saul Marquez: [00:17:16] Love it. Nice. I love that and big thing here is making those small wins you appreciate them. You know you take the man you smell the roses and you don't have to do these big you know you don't have to achieve these huge momentous things. You got to appreciate the small things too and you guys sounds like you guys do a really good job of that.

Tina Joros: [00:17:35] We try. We try.

Saul Marquez: [00:17:36] So how do you implement this into the culture right. I feel like a lot of times you could just speak to it. But how do you make this part of the culture of the organization.

Tina Joros: [00:17:45] Yes that's one of my biggest opportunities in the company. So in addition to just being an evangelist outside of our company for open and for connectivity with all scripts I do the same work inside of our company Allscripts has over 7000 people all of whom have very busy day jobs and they hear about the developer programmer API AIs and there's a learning curve that takes place inside our company as well. So I spend a lot of time with our sales services support marketing even our finance people. Everyone in the company to make sure that they're educated on how we work how we provide value how they can play a part in making this experience a great one for Allscripts clients. And so over the years we've done a lot of training. We've done a lot of making sure that especially client facing resources that are going to come across these applications in their day to day job. Understand how we work how these companies are working with us and we can take a look at our own internal processes and apply that same lens of trying to streamline to the same internal processes as well. So there's a lot of work to do internally and externally and we do both. So we spend a lot of time making sure that our own employees know the value that we're creating through this program and how they fit into the overall big picture as well.

Saul Marquez: [00:19:02] Yeah for sure. Now that's great advice. Tina what would you say an exciting project that you're working on today.

Tina Joros: [00:19:08] So there's a couple of things within our own developer program. I am really excited about continuing to streamline the business side for all the companies we're working with. So in conjunction with the usage based fees we're working on some automated payment processing through our developer portal which sounds easy. We go to websites to do e-commerce transactions all the time but yet in this industry when we're charging people for API usage we're still going to 30 days after the fact. Send him an invoice and give him another 30 or 45 days to pay it and it's a very disconnected experience where someone wires you money or sends you a check at the end of the day. And to me that is just not good enough. So inside our own developer portal to help our own partners and companies that we're working with streamlined their process we're working on automated payments so that they can pay the credit card the day after their transactions post and to me helping those improvements helped reduce the overall cost of maintaining this integration. If you need less business side resources to facilitate your integration with Allscripts then that is good because it helps bring down the overall total cost of your Shen so that I'm excited about industry wide I'm really excited about a couple of initiatives that are happening. We joined recently the Charron alliance. And this is a group of individuals that I think are doing some fantastic work on patient access. And we're working with them on what does that mean for a patient to access their medical records. What are the most important things that need to be in place to facilitate that exchange. I think they're doing a fantastic job and I'm also really excited about some work that the ANC is doing to define interoperability and determine how we're all going to start measuring it. You know I talked a little bit earlier about how we measure our data shares but I'm interested to see how as an industry we're going to start measuring did this actually happen. What is data blocking what does it mean to be interoperable is that different than just being connected. I think those are all really exciting things that are coming that were participating in those discussions. We want to make our voices and our opinion heard that ultimately you know we're going to get some guidance on that that I think will change how all of us operate in this industry and how we determine our next steps in the world of interoperability.

Saul Marquez: [00:21:25] Yeah that is so interesting you touched on so many hot topics there. Tina and it sounds you guys are involved in a lot of them. Maybe we have to do a part two to this because it's pretty interesting. Ok let's pretend by the way I think it's so cool you're doing very applicable. It sounds like you're doing some pretty amazing things just to make business easy which is what a lot of companies need. So you're an asset over there. Tina I hope you know that.

Tina Joros: [00:21:48] Thank you.

Saul Marquez: [00:21:50] Let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine today. It is the 101 or the ABC of Tina Joros. This is the syllabus we're constructing right now for the listeners for questions lightning round style and then a book for the listeners. You ready.

Tina Joros: [00:22:07] I'm ready.

Saul Marquez: [00:22:08] All right. What is the best way to improve healthcare outcomes.

Tina Joros: [00:22:12] Make data available where it needs to be to treat a patient.

Saul Marquez: [00:22:15] What is the biggest mistake or pitfall to avoid.

Tina Joros: [00:22:17] Over thinking and over architecting API.

Saul Marquez: [00:22:20] How do you stay relevant as an organization. Despite constant change.

Tina Joros: [00:22:24] Expect change you have to be flexible and adaptable. This industry is going to continue to change for many many years you should not expect it to stay the same.

Saul Marquez: [00:22:32] What is one area of focus that should drive everything else in your organization.

Tina Joros: [00:22:37] Quality and just the concept of being open. It's a big word but we live it we are the open business unit and being open means that you are creating possibilities and creating potential and that is really important.

Saul Marquez: [00:22:51] And finally Tina what book would you recommend to the listeners as part of the syllabus.

Tina Joros: [00:22:55] So my favorite book of all time is Jonathan Livingston Seagull by Richard Bach. I think it's a great reminder not to be afraid of the unknown to stay true to yourself and your instinct and that it's okay to be different and we're doing things differently here at all scripts so it's a challenge that I like to live by.

Saul Marquez: [00:23:11] That is so awesome. Tina listeners visit TINA. You're going to get all the lists of Q&A that we had here as well as the syllabus that we put together. Links to all scripts links to the projects that are going on and also a link to the book that Tina recommended. Before we conclude Tina this has been a lot of fun. I want you to just share a closing thought for the listeners and then the best place where they could get ahold of you.

Tina Joros: [00:23:40] Excellent. Thank you so much, Saul. And again I really appreciate the opportunity to share what we're doing here. We are not the only vendor out there but to the extent that you want to get connected with someone and have a great experience please go to and we're happy to help you with our process and get you started. Joining the AllScripts developer program. So thank you to everyone. My final thoughts are just to take that first step forward. It's not as hard as you think it might be and it can even be a great experience.

Saul Marquez: [00:24:06] That's outstanding Tina and sage advice again just want to say thank you so much for joining us. Super excited to keep up with what you guys are up to.

Tina Joros: [00:24:15] All right. Excellent. Thank you.

: [00:24:20] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Jonathan Livingston Seagull

The Best Way To Contact Tina: 

Mentioned Link/s:

Episode Sponsors:

Healthcare Podcast

Outcomes Rocket Podcast - Tina Joros

Outcomes Rocket Podcast - Iya Khalil

How to Reduce the Burden of Disease with Machine Learning and Mathematics with Iya Khalil, Co-founder and Chief Commercial Officer at GNS Healthcare

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:19] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I really thank you for tuning in and I welcome you to go to where you could rate and review today's outstanding guest because she is a huge contributor to Health Care and an amazing person. Her name is Dr. Iya Khalil. She is the co-founder and chief commercial officer at GNS healthcare. Dr. Khalil is a technology entrepreneur and physicist with a vision of transforming medicine into a discipline that is quantitative predictive and patient centric via big data analytic approaches. She cofounded two big data companies via science and GNS health care and is a Cohen Ventor of the proprietary computational engine that underpins both entities. She trained in theoretical physics at Cornell University and has more than 11 years of experience in big data analytics for healthcare medicine and life sciences. She has led several key foundational collaborations with providers pharmaceutical companies foundations and government agencies. Dr. Kalil's experience spans applications and drug discovery drug development all the way to treatment algorithms that could be applied at the point of care. She's a frequent speaker at industry events and conferences which is where I met Aiya and she's also appeared in several industry journals published several articles in the field and was recognized by President Obama himself at the White House dinner as a leading entrepreneur and genomic medicine. More recently she was named to the farm of voice 100 list of most inspiring people in the life sciences industry. She was recognized for her ability to build bridges across the life science and health care industry which is much needed bringing people together to harness the power of predictive modeling to change the lives of patients and that's exactly why we have her here today on the outcomes rocket. So I want to welcome you to the podcast Dr. Khalil.

Iya Khalil: [00:02:23] Thank you and thank you for having me here today.

Saul Marquez: [00:02:26] It's a pleasure. And so I wanted to ask you just to kick things off. Why did you decide to get into the health care sector and why AI.

Iya Khalil: [00:02:34] Yes. So my interest in this field started in 2000 right about the time that I finished my Ph.D. in theoretical physics from Cornell but it was also the time that we had announced the sequencing of the human genome which is a huge monumental feat that involves both private and academic efforts to the NIH to get it done. But it was also the moment at which you know for the first time we could actually measure every base pair and our genes. We weren't just looking at one gene at a time but we could look at everything and this really paralleled sort of how I thought about systems as a physicist which is you go in and try to measure and get as much data as you can as on that system and then use modeling and algorithms and computation which is really what AI is to help you model it and make predictions. And it became clear that could we use the same powerful approaches that helped us predict the Higgs boson many decades before we discovered it or theorize about gravitational waves which we have that recently measured. Could we use this in healthcare and make it more predictive. You know if we could send a rocket to the moon with technologies around data and computational and I why can't we do it and use it to make precision medicine of medicine even better.

Saul Marquez: [00:03:52] I think that's so great. Dr. Khalil it's one of those things where it's you ask the question and great leaders like yourself ask the question why not not why. And because of your thinking it's led you to create this amazing company and you guys are doing some great things today. There's a lot of buzz in healthcare around artificial intelligence and machine learning. How do you think it's going to change the way health care is being delivered.

Iya Khalil: [00:04:16] There is a lot of buzz and it's causing a lot of confusion and now that doesn't mean that because there's confusion there are real things happening. You know a lot of progress is being made on being able to leverage data of all kinds in our space whether it's data coming from a text from physicians notes to being able to measure and sequence your genome. But there's a lot of definitions out there and it's good to clarify and so really what I'm focused on is using AI and its most powerful form and I'm using a form of ADD that I like to call causal machine learning and it's really transforming millions of data points that we can now mashers from the data that we can collect which we have to recognize. We weren't able to collect this data really well two decades ago. We can now we can go into a patient and measure their genomes and look at long attitudinal detail the electronic medical records labs claims and then leverage that using causal machine learning to learn the causal relationships underlying that data and really learn what's behind that data. Weekend In Silico start to run simulations and ask very specific what if questions down to that patient down to what's going to enable us to treat that patient accurately and precision what the right treatment is. And that opens up all sorts of doors in the industry and in places where they're currently sort of bottlenecks you know how do we better stratify patients for clinical trials so that we're giving the right drug to the right patient and we can better and more quickly get drugs through the approval process. How do we help health plans do a better job of making sure that the right interventions are getting to their members at not just the best quality but also you know optimizing across cost and optimizing dags with that individual helping providers do a better job of delivering care. So this ability to predict and learn from data it's really really powerful. This is what is at the heart of AI and machine learning is our ability to learn. And now we want to take that and apply it down to the individual patient to get better at optimizing their treatments and their health.

Saul Marquez: [00:06:20] That's fascinating Dr. Khalil and this causal artificial intelligence that's really helping your company deliver value not only to pharma but it sounds like also payers as well as providers in a big way.

Iya Khalil: [00:06:35] Yes. It cuts across everything that we do there and much in the same way that algorithms machine learning AI cuts across everything that an engineer might be doing right. This might be doing it at the heart of how you are able to come up with insights and help her. Our goal is to take those insights now and have it impact the patient.

Saul Marquez: [00:06:56] That's wonderful. So there's no doubt you're adding tons of value today in five to 10 years. Let's get into the future what do you think health care looks like and how does artificial intelligence change how medicine is practiced.

Iya Khalil: [00:07:10] Yeah really great question. In five to 10 years I'm hoping that we're at a place where in terms of the kinds of interventions and treatments we can get to patients we now have just a much bigger plethora of options right gene therapy is coming on the right stem cell therapy so we're going to have all sorts of ways of treating patients that go beyond just traditional drugs. And then the question's going to be what is the right treatment for that individual. And right now today you know for me as an AI machine learning expert to get a hold of that data that allows me to create the algorithms and learn and make that prediction. There's just a limitation. Sometimes I can't get all the data that I need. Griz also limitations around sharing of data and the data is siloed. So I'm hoping that five to 10 years our ability to access data and that scale on many individuals is just will no longer be a bottleneck and we'll have now systems and processes in place for layering the machine learning and AI on top of the data so that we can get to accurate and more better predictions for individuals.

Saul Marquez: [00:08:09] That's inspiring to think of the possibilities. Once those obstacles are lifted and as health leaders strive to give the best to their communities as pharma companies look to put together the best of what they can to deliver new new medicines to patients. What do you think is at the forefront of their minds a hot topic that you should be on every health leaders agenda and how are you and your organization approaching it.

Iya Khalil: [00:08:34] Yeah you hear a lot about rising costs in healthcare and that the numbers just don't add up right. We don't necessarily see better outcomes with just more spend and it's an interesting statement for people to be making these days especially when we are literally living through one of the most transformative times in healthcare. So much innovation is happening right. And there is a bit about sort of how are we going to pay for this innovation. How are we going to afford it. And in my mind that the real sort of power that AI has is to really transform healthcare into a precision medicine model so that the innovation and the new treatments that we're bringing to patients we're spending it on the right patients. We're actually figuring out ahead of time who's going to benefit who isn't going about if it had a better benefit patients. And when we can be precise about matching interventions and treatments and drugs to patients and know ahead of time what the outcome is and actually get that right then I really believe we can start to move the needle towards you know lowering our total costs of care are making this innovation affordable for everybody.

Saul Marquez: [00:09:38] I think that's such a great call out. Dr. Khalil and a lot of folks look at things like evidence based medicine. It's really kind of just average based medicine right at the end of the day. Right. And so what you're saying just resonates with me because it just provides an opportunity to get a pinpointed precision strategy for each patient.

Iya Khalil: [00:10:01] Exactly. Exactly right.

Saul Marquez: [00:10:03] It's amazing. Can you give an example to the listeners of how you and your organization have created results by thinking and doing things differently.

Iya Khalil: [00:10:11] Yeah I first want to call out that it's not just about the algorithms you know what allows us to do these things really is the abberation aspect and we fundamentally believe in taking now. You know that smart brains are physicists and mathematicians and engineers and marrying it with clinicians in the clinical community and the data we're so fortunate we have the option to do this now with many great institutions. One of them is the Multiple Myeloma Research Foundation which is committed to a finding and bringing better new treatments for most myeloma patients. So we set up a collaboration with them they have an initiative called Compass that people volunteer to submit their samples and data and Amamoor often takes on the responsibility of measuring now in their tumour cells what are the genetic and genome and drivers of the cancer what are the molecular changes that happened in the cancer. How does the outcome of that patient change over time as they're given different treatments and we have Machine learning and company are you going to access the data and we generated algorithms that are trying to learn the response of patients to that treatment based on that data. So we looked at a specific question which is a really important one which is a decision around stem cell therapy and who is benefiting from something that could be great benefits to it and there might be some patients where they may not be getting downshifted and we'd love to know who they are and what we can do to change their course of treatment ahead of time so they do get better fit. So we Legro that data to learn use causal machine learning Taggett learn algorithms from that data that would make that prediction and then took in those predictions and went to did the Dana Farber Clinical Center here in Boston to validate those patients and we're starting to see some really great validation results. And this work this ability to learn the markers that were potentially predict benefit was all done once the data was collected computationally and within months less than three months. And then by one of my engineers and then him taking those results and working with clinicians to validate them and seeing how we can then get to the next step up eventually and hopefully delivering that insight to the patient.

Saul Marquez: [00:12:15] Such an insightful project Dr. Khalil and it's awesome to hear you talk about the importance of those partnerships at the core. I feel like it's easy for founders to get seduced by their technology and it's so great to hear you just talk about that with as much passion as you do about the algorithms. What would you say was one of your proudest leadership experiences in medicine to date.

Iya Khalil: [00:12:39] So I mean when you're an entrepreneur and you're out there itching and trying to recruit people to come to your company and also join your cause your leader is often tested and you have to figure out more and more ways to motivate people and get them on board and I've always been very passionate about that especially in machine learning and I'm helping bridge understanding and get people on board but I think one of them may have come up more recently because I'm learning more and more I can only interact with people there's a sort of a limit to how many people I can speak to and it becomes sort of how you're able to represent. So I've been given the opportunity to serve Barnum Charlie Baker is one of his counsels for Chiha which is a hub around all of the information and data collected in the state of Massachusetts on our health care system and with the goal of being able to see that data to measure it and create metrics that help us make health care affordable for everybody here. So to be able to be part of that and to be at that intersection of how I can serve my government and health care right and reach.

Saul Marquez: [00:13:40] Pretty awesome.

Iya Khalil: [00:13:40] Yeah. It's really amazing and I think it's also sort of that to represent. Right. So still not many women and minorities and whatnot serving on some of these things and to get her to represent and hopefully provide that leadership through example and reach more people.

Saul Marquez: [00:13:56] I think that's so wonderful. Congratulations on that. And just a trailblazing for the ladies in health care. In fact I really look at this Dr. Khalil as an opportunity. I mean I feel like in health care a lot of women are starting to come out like yourself to really make a difference and put not only the technology but also the heart into improving outcomes. Can you tell us a little bit more about an exciting project that you're working on today.

Iya Khalil: [00:14:22] Yeah so one of the things that one of the trends that have been happening is more and more pharmaceutical companies are collecting data early in their trials on their patients and data. Beyond the detailed clinical record data on the genomic level molecular level. So we can see the molecular and granular changes that are happening in the individual patient as they're given these new treatments and new drugs and we're taking in that data and using causal machine learning to learn about who really truly is benefiting. Where there might be still some patients that don't benefit. And with that learning using that to inform the next trial from a face to face 3. And the goal is to hopefully enable you know faster better approval of new treatments and where we're targeting the right treatment the right patient. You know I'd love us to live in a paradigm where we are using these trials to learn really what's working and for who and where machine learning is enabling that faster and better so that we can get better treatments to patients much sooner than we are today with much higher success rates.

Saul Marquez: [00:15:26] Well there's no doubt that your efforts are going to be creating some major ripple effects for everybody listening to this. So listeners it's one of those opportunities for you to just understand and learn more. We're going to share at the end of this episode how you get in touch and research the company. But before we do I just want to walk through a little program here with you close to the end of the podcast Dr. Khalil you and I are going to build a leadership course on what it takes to be successful in healthcare today. It's the 101 of Dr. Iya Khalil and so we're going to write out a syllabus a lightning round with four questions followed by your all time favorite book for the listeners. You ready.

Iya Khalil: [00:16:06] Yes.

Saul Marquez: [00:16:07] Awesome. What's the best way to improve health care outcomes.

Iya Khalil: [00:16:11] Precision medicine.

Saul Marquez: [00:16:12] What is one of the biggest mistakes or pitfalls to avoid.

Iya Khalil: [00:16:16] Understand the problem that you're trying to solve. At every level clinically biologically and then really come up with the right solution. Now whether it's infrastructure people but also the technology.

Saul Marquez: [00:16:27] Love it how do you stay relevant as an organization. Despite constant change.

Iya Khalil: [00:16:32] One of our models is we're going to use the most powerful mathematics possible and do the most rigorous science.

Saul Marquez: [00:16:37] Beautiful. What's one area of focus that drives all else in your company.

Iya Khalil: [00:16:42] Solving what we call the matching problem just for every patient being able to predict ahead of time what the right treatment what the right intervention is at the right time.

Saul Marquez: [00:16:52] That is a moonshot and I love that you guys are thinking big like that. What book would you recommend to the listeners as part of the syllabus.

Iya Khalil: [00:17:01] I'm going to give an unconventional sort of advice. All right let's hear my people go what are you doing. So it's called Causal Inference and statistics a primer.

Saul Marquez: [00:17:12] Right. There we go

Iya Khalil: [00:17:14] And you don't have to read the whole thing. If all you do is read the first chapter and just get through the first round I guarantee it will just transform how you think about data statistics and what it can do for medicine.

Saul Marquez: [00:17:27] Amazing a great recommendation. And listeners don't worry about writing that down. We're going to provide all of that to you on the website. Just go to and you're going to find all of the show notes a transcript of our conversation today as well as links to the things that we've discussed including the GNS health care website. Before we conclude I love if you could just share a closing thought. And then the best place where the listeners can't get in touch with you or follow you.

Iya Khalil: [00:17:59] Thank you. So my closing part is that a lot of noise in our marketplace right now with all the buzzwords where there's machine learning and data. But the buzz is real and there is real steps behind it. And really for those who want us to get to that next level in medicine health care you know it's upon all of us to really learn about what's happening and to figure out how we can contribute to making medicine and healthcare better for all of us.

Saul Marquez: [00:18:23] Beautiful and what would you say the best place for the listeners to get in touch with or follow you.

Iya Khalil: [00:18:28] Right. So two ways. I'm from Linkedin so I love to connect to be that way. And then GNS health care we put out a blog that to release content and hopefully also you know help really people understand the space better and get them involved better so we'd love it if you would join our blog as well.

Saul Marquez: [00:18:46] Is that on the GNS website?

Iya Khalil: [00:18:50] It should be.

Saul Marquez: [00:18:51] Outstanding. So listeners will go ahead and include that link to the blog. So you could stay tuned in to Dr. Khalil and what her team are doing because today has just been the tip of the iceberg. And so I want to just give you a huge thanks from everybody listening Dr. Khalil and we're looking forward to staying in touch.

Iya Khalil: [00:19:10] Thank you. My pleasure, this was a really great session. I really enjoyed it.

: [00:19:17] Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Causal Inference in Statistics: A Primer

The Best Way To Contact Iya:

Mentioned Link/s:

How to Improve Operations and Outcomes by Considering Human Factors with Dr. Adam Probst, Director of Human Factors Clinical Operations at Baylor Scott & White Health

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Outcomes Rocket listeners will come back once again to the Outcomes Rocket podcast where we chat with today's most inspiring and successful healthcare leaders. I want to really thank you for tuning in again and I invite you to go to where you could give us a rating and review. I really enjoy hearing from our listeners and just hear in the feedback as well as things that you enjoyed or want us to do better. It's just what makes the show better and what makes us give you those tidbits of information to help improve outcomes in whatever area of health care that you're in. So without further ado I want to introduce our outstanding guest. His name is Dr. Adam Probst. He's a director of Human Factors clinical Operations at Baylor Scott and White Health. He has an incredible amount of experience in the area of human behaviors and health care and he utilizes innovative methods and approaches grounded in human factors and systems engineering framework to create a robust health care work stream that helps see outcomes improve. I want to welcome Adam to the show and also want to thank Dr. Ballard for the introduction to this amazing gentleman that's doing so much for health care so Adam welcome to the podcast.

Adam Probst: [00:01:36] Thank you very much. I'm looking forward to appreciate the opportunity.

Saul Marquez: [00:01:40] Absolutely. And so Adam let us know what is it that got you to decide to get into the medical sector to begin with.

Adam Probst: [00:01:47] I somewhat grew up around it you could say my father was a PCP. Growing up you and I you know I was really involved in his clinics really really enjoy the concept of being able to help people and you know naturally wanted to follow in his footsteps growing as I matured. I remember going you know he would introduce me to health care by we would watch surgery videos that he would bring home that he you know he was having me memorize anatomy and different functions of the body when I was in sixth grade. You know just to kind of help me get prepared. So I was always really really interested in the field. Unfortunately he and I were in an auto accident when I was 14.

Saul Marquez: [00:02:20] Oh my goodness.

Adam Probst: [00:02:22] Killed he didn't survived but I'm one of the things really well thank you. One of the things that really got me interested is you know I was pretty severely injured in there and over the years I've had about 16 surgeries orthopedic you know even joint things and so I've always stayed really involved in health care. But it became really close with the orthopedic surgeon that has performed most of those surgeries for me and it began to kind of shift and say well maybe I would want to go from kind of a primary care role into more of a specialized skill perhaps or edicts. So I joined his office as a medical assistant throughout most of high school and in the first few years my undergrad at Texas Tech Gotzkowsky the behind the scenes working he would take me into the doors with the Met get to see a lot of providers lot of hands on things and so I got to say pretty involved through healthcare and my passion kind of yeah I'd lot of really great mentors that worked in the field that kind of took me under their wing and were happy to kind of show me how health care actually operated and how you can actually interact with patients. But my junior at Texas Tech I met just through happenstance taking an elective. Isn't that part of my undergrad curriculum. I met a professor Dr. Keith Jones there who was a human factors engineer and he was one of the at the time was a pretty small program at Texas Tech a human factors program there. But I was really intrigued by the field it sounded really interesting. I was just looking for some stuff to do and so I was asked and granted permission to join his lab as an undergrad research assistant and he did a lot of his work in robotics human computer interaction. So I got to kind of see the build from that inside perspective from human factors learn more about it. I had like most people had never really heard about it. The field has been around since World War II but very few people are really familiar with it and get a lot of really great research experience with him. But I love that whole process. I really began to see that I thought human factors could be applied to healthcare of the same principles no human behavior reliability increasing safety and processes and that sort of thing like this is a perfect marriage with healthcare. But at that time this is you know in the early aughts right around 2000 2002 there really weren't any applied Healthcare Human Factors folks do working. There were some that were working and in research capacities that maybe affiliated with some medical schools or hospitals for example. But there were no really applied human factors it was all kind of academic type approaches. So you know I decided that the human factors as a field for me. I think this would apply to health care. I wasn't really sure how that would work or what that would lead to. But when I started my doctoral program I was partnered with my graduate advisors or came from the field of judgment decision making specialized and medical decision making particularly and so drug Régis school I got a lot of really good experience helping to design some patient decision aids and the know for making cancer treatment decisions how do we help patients understand the difference between a specificity and sensitivity of treatment options. Some of those kind of more abstract concepts. So that was kind of really the only thing that was the point that I could find in Healthcare Human Factors. But I had the opportunity to Internet NASA at the Johnson Space Center where I worked in a division they called the Utah have a usability testing and analysis but they had one of their human factors engineers there who was really really interested in working with the crew medical officers in trying to design some tablet based tools for them to use to treat injuries. So you know an national gets injured in Reno from a cut to a life threatening injury in microgravity. So I got to do some really neat research with her kind of figuring out how can we provide tools at the time of care in one of those really unique settings such as microgravity. But after I finish my internship I was lucky enough to wear a hospitalist from Children's Mercy Health System in Kansas City. One of those physicians it was you know really passionate about safety and health care and learned about human factors and wanted to know more about it. And you know at Wichita State we were kind of the closest program to his hospital system so he reached out to my advisers kind of a natural fit. She was the only one doing research in health care is parsing of factors and so he and I began to partner and collaborate on a few different research projects that kind of led to my dissertation which was a PI medical decision making and kind of choice architecture and things to optimize ordering practices of physicians would we kind of focused on laboratory ordering for interest that there more recent yarder more common pet owners or you know failure to drive some of the more common diagnoses they were eating. So this is when it jars we're just kind of rolling out people were trying to figure out how to use them they didn't know how to design them. Most of them many of them still are not necessarily designed in what you would call high functioning or even have great usability. And so luckily as I was winding down that dissertation work. Keith Jones a professor at Texas Tech. Kind of started all this. He's one of my first mentors and he and I still stay in touch. Send me an e-mail said Hey I know you want to get back today. I was there. I'm from Lubbock and the West Texas area because I want to come back to Texas. Michael good native Texans wanted to do. But he goes there's a health system there at the time was a legacy Baylor Health facility goes they're starting a human factor program and they want somebody who can do some applied human factors work and it was just the perfect opportunity that I was looking for and I jumped on it you know applied them and luckily was hired and over the last seven years I've been at what is now Baylor Scott White have kind of works in this director position that is 100 percent applied in the factors in healthcare. I do do some research on the side and try to publish when I can but for the most part you know I get to follow my passion which is being out with the providers out with the clinicians on the unit. You know I just got back from a two day trip to our Austin area hospitals I'm working on some of the Awaran sterile processing work and so I get to really be out there and get my hands dirty so to speak. And so you know I kind of throughout my whole life has really been interested in healthcare. And then as I am passionate about human factors and then luckily this one position opened up here that it was just the absolute perfect opportunity for me.

Saul Marquez: [00:07:54] Adam that is so interesting and your journey is amazing. It started early with your dad. Then it would lead to the unfortunate accident but yet you're still through that time found a way to stay focused and your heart stayed there and you were taken in under the wings of many different leaders listeners. You are the average of your five closest peers. So the people that you surround yourself will determine your future. And what you do and as you surround yourself with some amazing leaders that help you pave a way into a really unique niche human factors in healthcare. And now you're sort of leading the way so congratulations an amazing story. I really appreciate you sharing that with us.

Adam Probst: [00:08:38] You know I. Yes without a doubt those other leaders that are you know took the time out of their busy schedules you know to help a kid that really wasn't sure what he wanted to do. Like many of us as we try to grow up and a bit older and more richer. But each one of them left a very big impact and each one grew me in different ways and Yan Chao who is now no longer with Baylor Scott and why but he was really one of the first human factors in healthcare he worked at the University of Maryland is a senior professor in anesthesiology department doing both research into the Pi projects but he began kind of the groundwork here at Baylor Scott White for human factors and he did such a great job that they said hey we want to hire another fulltime Ph.D. to come in and try to work on applied stuff. So you know he was a he left a great mark on me in terms of how to actually bridge the gap going from graduate school to actually how do you take some of that stuff you've learned in and work in everyday life. And so each one of those leaders has made a huge impact on me. I've been very blessed to have some great mentors throughout the journey so hopefully I can provide that other forces are coming up as well.

Saul Marquez: [00:09:35] Now a true blessing at all. And you know I think it's it's a wonderful opportunity that you have in your hands. Can you give the listeners an example of how you guys have created better outcomes with what you're doing.

Adam Probst: [00:09:50] Yeah we're happy to. Luckily or unlikely however you would like the phrase of the you know there's a lot of opportunity in healthcare right a lot of different things to focus on. One of the things that human factors brings to health care and you get a lot of questions that aren't you guys very similar are lean and doing a lot of Six Sigma pipework. There is quite a bit of overlap we're trained to look at differently. But human factors you know really is looking at ways in removal that definitely has a huge part to play in healthcare as it continues to try to shrink become more efficient and cost but human factors really focuses on the what you call the people side of that. So it's kind of a blending of several different fields where it's what you call the imperial side of psychology and your cognition perception decision making motor control. Basically how we interact with the world around us what people are good at what the better. And it applies that with industrial and systems engineering and design. So it gives us a lot of opportunity to kind of say OK we know what people can do well just naturally and we know what people struggle with just from our own cognitive and information processing capabilities. So how can we help design systems to make them safer in one of the key tenants that we really really look at. Is what we call the work system. You know a lot of different fields have similar concepts and similar names but it IIMA factors especially in healthcare when we talk about the work system that we try to focus on to drive some of the outcomes is really the intersection of you know the people the technology the processes. Sometimes it's our own policies and procedures that we hamstring ourselves with. So by looking at that work system we're able to kind of get the whole picture if you will which I think leads to a lot more sustained improvement. And I'll give you kind of an example one of the projects I'm really really proud of is a nursing leader one of our facilities is doing very engaged rounded with frontline staff cosily kind of very much had an open door policy to get some of her nurses in there to say hey we're really struggling with this or I have an idea I'd like to work on but this particular facility was a thousand bed facilities one of our flagship cities very very large very very busy very high IQ patients is a new way of saying that right. But while during rounding the nurse brought up to the chief nursing officer there that were not happy we're overloaded we're working too hard we're making errors just because we're trying to do too much and none of that would probably be earthshattering news to your listeners or anyone who works in healthcare right. But the Theano began to really dig into it and looked you know as all good leaders do begin to really get her hands around this figure out what was going on there and what are some of the areas we think are attributable to this overload of the work system. So what they found is that despite maintaining a constant ratio of 1 to 5 and a med search unit for example or a 1 to 2 in an ICU the nurses national database of nursing quality indicators Indian IQ scores were really falling and our error rates have risen by throwing you know every technology we had that we had a jar we had barcode scanning we had all the stuff you're supposed to have. Oh we were still having these these kind of errors. And so the CEO who had worked with on a few projects previously called me up one day out of the blue and just said you know I think this is something human factors can work with to both increase our staff satisfaction but more importantly to reduce their workload and allow them to have a better working environment and also more importantly make patient safety and drive or outcomes. And so that kind of kicked off what it eventually became over a yearlong project that one of the nurses ended up kind of dubbing project sanity which I've got property. I don't have a marketing brain so I had some kind of nebulous human factors terms. She's always just a. You got to give it a funny thing right. Everybody likes to resonate with those. So we really begin to apply some human factors methods to really understand that clinical work system. A lot of that's done via observation. I'm a firm believer just because of how busy everyone is that we really don't have the time or we don't make time to go out and just watch what our health care workers and staff and from any level are actually being forced to work in and what they are trying to accomplish. And so we really began to focus on you know what are some aspects of their broken work system we think could really drive some improvements at that particular units. We had a few pilot units we were working with and start began running through a series of CTCA cycle improvements that we really complete the redesigning almost the entire work system our nurses were operating in. You know everything from how we were managing supplies and storing them how do we reduce and mitigate a lot of these interruptions that we know are leading to errors. How can we streamline and improve our medication administration process and even how we're even educating our patients on their care. And so we kind of had several interventions we began focusing on looking primarily at the med prep workflow and administration supply management and work efficiencies. But one of the big ones was How can we really in today's climate where everybody is literally a touch screen away from being interrupted or you know how can we really begin to understand and mitigate some of those interruptions. And so throughout a yearlong cycle we went through several different iterations of this and we actually ended up we calculated that we saved about 250 minutes per nurse per shift in the ICU and 160 minutes per nurse per shift in the Med surge. Yeah it was you know given them actually time back to what they're trying to do what they like to do and what they have a passion for which is treating patients and being with patients. And we did that all through the redesign of the works as that we didn't add a single FTE. We didn't hire more nurses we didn't hire more patient care techs. So that was Neba one of the really cool things that we found out after we implemented this went back a year later and said let's go look at our nurse reported medication errors and see to have an impact on any of those. And so the ICU unit tohe from you know we did a year before the interventions and a year after the interventions so we went back and looked in the ICU from 11 events to zero from admit errors and then the lead surging it went from 52 events to 12. So yeah we actually you know thanks to all the great literature out there you could pretty easily calculate what the estimated adverse drug event costs and we we estimated that that saved that particular facility about 500000 dollars a year. So you know you went further. Yeah it was great. We went a bit further and said OK well what are you know how can we better quantify. Not only from the nurse supported error rate but how can we better quantify what are we doing for and versus actual workflows and workloads. And one of the facilities we've done this on had a nurse tracking system and we were able to use that tap into that data and basically as an example they were running back and forth to two different medication rooms there were all different. It was led to a lot of interruptions or partial med administration that would start passing that I forgot to grab this then I would have to go back and you know a lot of walking around a lot of wasted time and potential opportunities for error because as you're walking around you get distracted more interruptions. It was where you were in the workflow for example and we were able just to redesigning the way that we manage their interruptions and supplies and the way we streamlined the Med prep process where were able to reduce their recurrent visits to the medication rooms by over 30 percent. And so you know they actually calculated to spend about one point one hours less every day walking around trying to find and administer medication. And so we really said OK well how do we get this out to the masses. Right this regimen is on a few pilot units. How do we really diffuse this. We're really big on diffusing some of these practices obviously. So while that was really successful project you know Baylor has a really great quality improvement some of that they do every year is called the blast and quality improvement summit and what it is is designed for projects like this that can be done by anyone and have a very formalized CTCA cycle isn't it. Have your data in a certain way it's a very structured process but it celebrates some of these outcomes and things and so we use that as a platform to kind of get the word out we applied and we won first place that year. So thank you. Thank you. And so that got a lot of other facilities interested in doing that type of work and so you know we ended up publishing this work and journal nursing administration and then began to kind of spread it and as we went from beyond the ICU and the Med surge units we went into you know Cub units and oncology units and labor and delivery units orthopedic units and so we've kind of created a standardized toolkit now. And I actually had a meeting early yesterday morning with the nursing director in our central Texas division when I was down in the Austin area who had heard about the work and said hey we meet for breakfast while I was up to. And so I was able to hand over a toolkit that says OK here's our process here's your data collection methodology. Here's how he recommends you. You kind of frame this work out. The type of people you're going need on your team all that you know multidisciplinary approach. And so I was able to hand over this toolkit and now she can take it and run with it and implement it there because there is one of me and a system of 45000 or so. Being able to find ways to drive these outcomes through kind of this diffusion mechanism is really critical as part of what we do. So basically that project started off with the Seno a good leader who was engaged and actively listened and was concerned and didn't just kind of have the checkbox I look at I got to do my rounding today but literally listened to it and thought hey you know I think human factors and you know really really help with this and started on a way of just trying to focus on how can we make the nurses work life easier which obviously is really really important because we want them focusing on patient care and not on oh I have to spend a third of my time documenting the HR. You know we found a lot of really great reduced Menderes you know patient satisfaction scores went way up reduced time spent wasted and walking around and so we had a lot of really really great outcomes all because of a leader who said yep I think I can help you with that and then use some system resources. One of the benefits of being such a large health system we have a lot of really great people who really need work and so we could tap into those. And so that's that's one of my my favorite examples of how Max Baucus has been applied and by looking at that clinical work system you know how can we really redesign it and reduce error and make things more cost effective which is you know health care has to do that.

Saul Marquez: [00:19:19] That's so great. Appreciate you sharing that amazing story. It's such a great thing that you were able to create a tool kit to disseminate to diffuse to just scale it out. And congratulations.

Adam Probst: [00:19:31] Thank you.

Saul Marquez: [00:19:32] One of the things that I wanted to ask is you've had success. Give us an example of a setback that you had and what you learned from that setback.

Adam Probst: [00:19:41] Oh yes I did put some thought into this one and it was this was very early on in my career here at Baylor. It was one of those things as nursing leaders and physician leaders throughout the system we kind of became aware that OK we have this team of factors program we're not really sure what they do yet but we think we have some different projects we might want them to work on. And one of the nursing leaders at a facility really wanted to work on the redesign of their crash cards. They wanted to make it more usable less searching time actually designed the way that we were buying the cards. We can't change the cards but how can we stop the cards differently and that sort of thing to make it more accessible and will be Aster Su Holbeck who who's now at Mayeux. But at the time was that and Nebraska had done a project like this and I know her professionally and reached out to her and said Can you give me some lessons learned on what you did and she had a lot of really great work on some ideas on how they redesigned the crossguard but what I learned and where that failed is I took that and ran with it but did not have the time or I did not take the time I should say to make sure I had a really engaged team. It was one of those things that the nursing leader was Yeah we want him back to help with this. And so I took that and it was a great idea. From my standpoint it made perfect sense on just my training in terms of human error and that sort of thing but did not have the time to get the frontline. I did not have the time to make sure of it. What can I do for you that works from a human factor standpoint this may make perfect sense but it does not fit your work does not fit your expectations and so basically that project went nowhere. I spend a lot of time on it is really frustrating from moment as a really good learning opportunity. So I learned from that that man you've really you know especially in today's world. Everyone's running from the new flavor of the month to the flavor that you're going to reduce falls. Now we're going to turn our attention our attention to a happy reduction or whatever it may be. I didn't build the team needed and get the engagement needed and get inside early on enough of the project. So when I came back with my recommendations they were like OK this isn't going to work for us. It may work on this one unit you worked with but it's not going to work on the ice use for example. So with a system as large as we are you've got to have that a project steering type team for our big initiatives. You've got to really have those those implementation folks because the one of the things I learned for me and one of the really good mentors that I mentioned earlier is that especially in patient safety and trying to reduce this at least us those of us at the corporate level don't own the process. The frontline staff to the ones that are actually treating the patients using the equipment were buying for them and asking them to use. So without having that kind of proactive approach to really understand what is a problem they're trying to solve. So can come through and it sounds great around a conference room table to say yet we want to make our. We want to design our crash car to have a standard layout for every crash cart across the system. So we have floating nurses or whomever. They're all the same. That sounds great around a common room. But when you actually go out and try to figure out how to implement that and defuse it if you do not get the right votes engage and you do not take their perspectives into account early enough on and have an ability to kind of not only just keep them engaged but how do you diffuse some of the work we're going to do then it's just not going to go anywhere. And so you waste the kind of spin your wheels quite a bit. And so that's what and luckily I learned that lesson early on and since then you know sometimes I do think that you know would be nice to move things a little bit more quickly and yet have this problem we're going to run with it and we're going to fix it in a couple of weeks and then move on to the next. It does take more time to get those folks engaged and involved and build a team that is going to own the process because once I'm done I leave and then they're kind of stuck what's left whatever the deliverable was for that particular project. And so luckily I learned that early on and I've applied it it takes a little bit longer and sometimes I think we would like but without those kind of engagement without that kind of multidisciplinary approach and looking at the true work system we're just not going to be able to drive any improvement going forward because it's just going to you know move on it and then whatever the next target is whatever the next project they want to work on is will take precedence and then it just kind of goes away into the.

Saul Marquez: [00:23:35] Very very real advice there. Adam and a great lesson to learn. We all face this. Listeners there will always be a flavor of the month like Adam said. And if we don't do the work to get the frontline engaged to get there by and to give us feedback and to make give them ownership in the process then the outcomes not going to be there so make sure you learn from this lesson. Adam Sharon Adam thanks so much for sharing that.

Adam Probst: [00:24:02] Yes thank you happy to. It was a painful lesson but a good lesson.

Saul Marquez: [00:24:05] But you learned early on and it's a good thing so I love that. Let's pretend that you and I are building a medical leadership course on what it takes to be successful in medicine today. The 101 course are the ABC of Dr. Adam Probst. And we're going to ride out the syllabus here with this lightning round so we'll get some quick responses to these four questions and then we'll finish it up with a book that you recommend to the listeners. You ready.

Adam Probst: [00:24:31] I'm ready.

Saul Marquez: [00:24:32] Awesome. What is the best way to improve healthcare outcomes.

Adam Probst: [00:24:35] Well I am biased obviously but I truly believe you know with as complex as health care has become with all the integration of technology and we we keep throwing technology at the problem and wondering why our costs aren't going down and why our outcomes aren't improving. Is that healthcare leaders really really need to understand how do we deliver care in the framework of this clinical and work system that I've been mentioning throughout the whole time. How all of this comes to go how that technology comes together what people behaviors will do you know culture change all that stuff that we don't understand the clinical work system and then it sounds like a very nebulous topic but it's really not so you never really going to hit the goals you have zero harms for patients. It really only Ciulei to do that usted understand not by sitting around and asking people around a conference table but going out and seeing and learning how health care is actually delivered and so by using that through the lens of a work system approach that human factors can provide. You're going to identify those barriers as that phase you're going to figure out what are our big challenges what are low hanging fruit versus things that are going to take a huge year long process. And so you know human factors can help with that. But I think Jim Collins has a really really great book and this isn't the book I'm necessarily recommending. We'll get to that I know but that gives meter's a kind of a key mechanism to achieve that is right. So it's good to great book is get the right people on the bus and then decide where to take it. So I think future health care leaders that we've got to approach things from a multidisciplinary approach everything's tied into each other nowadays the work system is very very complex. We're not getting any more FTE not going to just throw staff and money at the problem. We've got to improve the way our health care is delivered and so by understanding how that intersects together I think it would be step number one in really understanding how to drive outcomes for healthcare.

Saul Marquez: [00:26:16] What's the biggest mistake or pitfall to avoid.

Adam Probst: [00:26:19] I think and I see this a lot since I'm at the corporate level but I often think we fail by really not clearly communicating our system goals and how specifically individual units in offices and departments really dock into those efforts. For example I've found that you know frontline staff will typically know obviously you know what the general goals of their facilities like this know we reduce our folds by X percent or drop our Clapp's the rates or increase our age cap scores. But you know if you really sit and talk to a frontline nurse who knows what her unit goals are but say you know what are you doing and how can you talk into that. That will help drive and achieve the goals that the system corporate and other health care leaders have done. They often don't have they can't articulate that well you know I don't want a patient to fall. Okay that's great. We always want patients to fall but what can we do with you and how can we give you the tools you need in order to make sure that that doesn't happen and so you know I always kind of use that flavor of the month example. But we push those so often upon our frontline staff that it's really nebulous as to how they can really make a difference and that when what they can contribute on a day to day basis to actually help us hit our goals. So I think as healthcare leaders our job is to not only really set the goals for our system but really ensure the goals have a clear pathway forward. They have each staff member understand that everyone plays a role in this from any B.S. person to a senior V.P. of you know what can they do that applies. And what are some realistic and measurable differences and actual work that they can do to help us achieve those goals. I think we often fall flat on not articulating clearly enough how individual steps fit into the overarching symbols of performance.

Saul Marquez: [00:27:54] Straight call out Adam how do you stay relevant as an organization. Despite constant change.

Adam Probst: [00:27:59] It is a definitely a huge challenge that everyone is facing. I think continuous quality improvement is obviously going to be required to continue to do so especially with its healthcare leaders try to set a path for the future. Not really even knowing for sure what that future is going to be because no changes in DC and this we're going to have this type of healthcare coverage we're not we're going to change you know. So being able to really have that continuous quality improvement mechanism we have a really great way of doing that here at Baylor Scott White. We have what we call the steep global efforts these are our pillars are providing you know a safe timely efficient equitable patients. So we have a mechanism down that where people are given the tools and through a kind of a class type environment to complete a prior projects and say okay here's really how you're going to understand and map out workflows here's how you develop a charter is how you develop goals and aim statements and that sort of thing but it gives them a very PDC a rapid cycle improvement but it's training everyone from healthcare leaders that were required to take it from the director level of your Bailer or frontline staff who want to maybe work on a capstone project. They want to make improvements so giving them the tools and the ability to say okay here's some general structure around what you can do continuous quality improvement quickly within kind of teaching them and then turning them loose and let them go and actually make a difference. I think that's the net would have that mechanism to train your staff and to give them the tools to let them do those quality improvement initiatives. The only real way I think to keep that sustainment and stay relevant going.

Saul Marquez: [00:29:22] What's the one area of focus that should drive all else in your organization.

Adam Probst: [00:29:27] For us. And I think a lot of help you know everyone likes to say we've always put our patients first. Obviously that's why many of us are in health care. We want to make a difference in people's lives. We want to help people. But I think you know particularly health care leaders is really really focusing not only just on patient experience which is so important now because reimbursement tied to age test scores and all that but really just understanding and putting names to the faces of why we're really really doing this. Yes we all have a career. Yes we ought to make our ends meet financially and so we ought to have a job of some sort but we're really here to make a difference for people that we see in their worst right and who are. Nobody wants to go to a hospital nobody will be there. So you know really keeping that as a sinner and we've done that a lot through actually just sometimes it's as simple as putting a face with a problem is you know hey we're having this issue on over sedation. Well here's a patient that had a negative outcome. And this is who this patient was. They had family and friends and goals and aspirations. They wanted to do. And so I think keeping that centered and making that a priority. And sometimes it seems kind of almost colloquial or sometimes even cheesy or rah rah to say you know we want to put our patients first. But I think you've really got to make sure and not get stuck in the day to day of it. We so often fall into. Yeah. It's a job I'm doing. But that patience truly are the focus for what we need to be working on and the only way to really provide them the care that not only we want to give but that they deserve is to make sure that they stay at the center of every decision.

Saul Marquez: [00:30:51] I love it. I'm what book would you recommend to the listeners as part of the syllabus.

Adam Probst: [00:30:56] Yeah one of my favorite books is Stephen Casey. He has a book called set phasers on stun and other true tales of design technology and human error. An old book. It's kind of one of these but it's no different edited versions and more updated versions through the years. But it was really one of the first books I read there was Jones and others actually recommended to me when I became interested in the field of human factors it's basically a collection of disasters that occur when designers don't take the user into consideration. He uses a lot of airplane crashes but obviously there's health care examples in there just due to the way we're designing the equipment the machines that kind of we're asking folks to use and it really highlights what I think is a critical really understanding order to drive outcomes and safety is to understand the difference between use error and user error. Everybody like a lot of systems move to a fair and consistent culture type approach where we don't want to point fingers. We want to help everyone and we understand what was a process that broke down and all that. But we often sometimes we when person says they should pay. How could you give the wrong drug to do that kind of stuff. And so this is a really good framework of helping people shift that. Oftentimes people are just a result of the equipment the technology they're being asked to use. So a really good job highlighting that I would recommend that to the listeners for sure and it's a fun read. I mean not fun is a funny haha but it's very intriguing and interesting and I think it's a really unique perspective on how leaders can help drive healthcare by really focusing on. We've got to take usability and users and everything into account on the technology we're asking our patients healthcare staff to use.

Saul Marquez: [00:32:28] Now this is really great Adam and listeners an amazing syllabus we just put together here for you all and a great book. You don't have to write any of this down. Just go to that's ADAMP. As is Peter or P as in Probst. And you'll be able to find all the show notes links to Baylor Scott White all the books that we just talked about. And just the projects that Adams up to go to he you'll be able to find that there. And before we conclude Can you share one closing thought and where the listeners can get a hold of you.

Adam Probst: [00:33:06] They can get a hold me through our Steeb Global Institute as part of Baylor Scott White Health. We've actually done a lot of collaboration and almost as a consultant I've worked with systems that may not have human factors personnel available but you can get that through my Baylor Scott and White websites and then not have linked in profile. Please feel free to add them Jaro BSD. Feel free to reach out to me. They're always eager to learn and collaborate from other healthcare leaders. And yeah a closing thought is that and I'll give a brief but human factors in healthcare is now much much more common than it was even five years ago 10 years ago. I think a good example of that is you know there's a national team of factors and ergonomics nation and society that puts on a yearly conference for people working at Google and aviation and health care. But there's so much health care now that it has now a specific healthcare focus conference that it does on a three day once a year. And so I think you know as healthcare leaders move forward really want to make a difference is that it doesn't have to be human factors necessarily but really understanding that the work system we're giving our staff and what we're asking them to do is broken and then we wonder why we still have these safety events and we have these never events. And all this did happen. And it's because we've designed the work system in a way that is no longer feasible. Someone mentioned that healthcare is broken when the health care is up for healthcare is working the way it was designed to work. It's just it was not the. Well and so I think leaders moving forward by understanding this work system approach. You know we now have to look at it from a holistic almost 30000 foot view of understanding where all of this stuff comes together and that the only way to really drive improvement is not to point fingers at staff and say you should pay more attention or to hire more staff necessarily but has to really redesign and restructure the work system in which we're asking staff to provide care.

Saul Marquez: [00:34:52] I love it Adam. Well listen I think you hit the nail on the head with that you know health care isn't broken. It's working the way it was designed to work. And I encourage listeners to take some words of wisdom from Dr. Probes here and think about how you could involve the idea of human factors in the way that you improve outcomes in your facility and how you design your equipment or drugs to improve outcomes. Just want to thank you once again for taking the time to join us and really looking for you to stay in touch.

Adam Probst: [00:35:25] Yes thank you for the opportunity was great. I really enjoy the podcast and I love all the love. This is a great mechanism to try to bring healthcare leaders together look at you know how can we fix this broken work system from a number of different ways. Thank you for what you're doing.

: [00:35:41] Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Set Phasers on Stun: And Other True Tales of Design, Technology, and Human Error

The Best Way To Contact Dr. Adam:

Linkedin - Adam Probst

Mentioned Link/s:

Sponsor for the Episode:

Healthcare Podcast

How to Improve Quality and Increase Patient Safety with Dr. Joy Bhosai, CEO at ChatrHealth and Samantha Sim, Product Manager at ChatrHealth

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:19] Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring healthcare leaders. I want to welcome you again and I actually invite you to go to to rate and review today's typecast because we have two yes. That's two amazing guests. It's a first but it's exciting because there are two amazing ladies in health care doing outstanding things and I want to introduce them and then open up the mic for them to give a little more details of whatever I've missed. But first I want to introduce Dr. Joy Bhosai. She's the chief executive officer and founder at ChatrHealth will be diving in a little bit more about what they do. But joy is inspired by innovations that address gaps in access to high quality care. She's an alumni of Pomona College. A previous Fulbright scholar and a recipient of a master's in public health from Yale focusing on global health and management she is deep into this business. Ladies and gentlemen and also at the front line with her Ph.D. she worked with Health 2.0 directing the matchpoint program which paired large industry leaders with health tech startups. You all know math. Holt he was on our show. She worked a long time with Pam and now she's dedicated to applying innovations to ensure quality care for patients. And we also have Sam Sim. She is the product manager there at chatrhealth. Sam is passionate about applying innovations improving access as well. And she's really passionate about doing this and her B.S. in human psychology from Boston University allows her to do it in such a way that helps make the products at chatr really intuitive with the user experience. And so without further ado I want to welcome both of these wonderful young ladies and open up the mic. Anything that I miss that you gals want to fill in.

Joy Bhosai: [00:02:17] Thank you so much for having us. We're really excited to share some insights and dream with you and be part of this effort. The other thing I would just like to add just minor detail that I went to medical school. I'm a physician by training and I'm really excited about integrating public health innovations into the practice of medicine.

Saul Marquez: [00:02:40] Outstanding.

Samantha Sim: [00:02:41] Yeah. And for me I'm really glad you again saw we met at the Health 2.0 conference. So like you were saying we had a fun time there. So I'm excited to share more about what we do at our company and also maybe see if anyone else has any ways of thinking that they could share with us. It's just you know it's a good learning and I think.

Saul Marquez: [00:03:02] Absolutely Sam and Joy. Thanks for filling in the gaps there and definitely missed that major detail. Joy is a physician and her experiences with chatrhealth as a frontline physician helped in a big way and so one of the things that I love to ask all of our guests is what got you in the health care to begin with so I'll direct that question to both of you.

Joy Bhosai: [00:03:24] So my parents actually owned a nursing home for adults with disabilities. So I grew up actually starting off. We didn't have a lot of money so we lived in their first nursing home before everything grew really exposed taking care of patients from an early age. And I think that has always been at the forefront of my mind. It's gotten more interesting later on in life is the intersection between all the social factors that go into taking care of it he says which I find really interesting and that's quite a really exciting field.

Saul Marquez: [00:04:02] Super interesting thank you Joy.

Samantha Sim: [00:04:04] Sam Yeah. And for me I'm not quite I wouldn't say I'm quite into the medical sector. I did actually recently graduate and lace up a very fresh perspective. Thank you. Thank you. Thank you. It's a fun exciting time I think I think really what got me into the medical sector specifically healthteach I would say is that I was actually in school studying a lot of really deeply scientific stuff so really hard sciences so biology chemistry physics. And I think I started to miss a lot of the human perspective of things. So we learned a lot of like how did this come along and how to treat them like this. Basically I would say I was so undergrad and then a lot of nitty gritty stuff. And I guess just the human touch and things. So I was really interested in public health. And then I started learning about health tech and all the cool thing that I didn't even know could be done these days with technology. And that's when I really started to learn a lot more about the intersection of healthcare and technology and I'm still learning right now. So it's an accident.

Saul Marquez: [00:05:12] I think that's for sure and I think everybody no matter how long you've been in health care is always learning and Sam you've got the awesome leadership of Joy. And you know you get to kind of combine your your new perspectives with her experience and it's exciting what you guys are creating right now. What would you say and I'll leave this question for Joy. What would you say Joy should be a hot topic on every medical leaders agenda today.

Joy Bhosai: [00:05:37] This is a big question. I mean I feel like there's so many things to work on but the thing that we're most passionate about and I'm always thinking about no matter what kind of patient I'm taking care of is how to keep them safe so quality improvement and patient safety is going to be a huge growing topic as the years progress especially now the way the healthcare reimbursement and everything is structured so how do you improve outcomes for patients and how do you make sure the process is safe and effective. I think that's going to be at the forefront of a lot of the old leader and helps us we gearshift agenda for the years to come.

Saul Marquez: [00:06:21] And what type of approaches chatrhealth taking. As far as patient safety that's unique and that's improving outcomes would you say.

Joy Bhosai: [00:06:29] Yes so we systematically work on patient safety module checklists the various tools to improve communication between not just provider but with their care he said nursing technicians anyone who really touches that patient during medical procedures. So we have a variety of tools that our main one is a use of patient safety modules or dynamic checklist that are used in the operating room. So to make sure that everything from set up to the procedure itself the surgery to when the patient comes out in recovery is effectively manage and making sure that no steps are forgotten or left behind.

Saul Marquez: [00:07:15] For sure. And in an area like the operating room when you have typically changing shifts and turn over I definitely see the importance of that. And Sam I don't know what type of thoughts have you guys been putting into the development of these are these products or as it relates to the core issues that we face in the OR.

Samantha Sim: [00:07:34] Yes. So I think coming into chatterer health and also learning more about what technology is out there for healthcare. I think I've noticed that there is not. I mean there's some effort but not as much focusing on patient safety and quality of care and it's not often talked about which is a shame because in some of the recent studies that have been shown there is a Hopkins study as recent as 2016 that shows that preventable medical errors actually the third leading cause of death in the U.S.. So we have got big just really big statistics like that that we seem to be ignoring. I think it's really important work that we're doing. And just one of our main products that Joy was talking about. So the medical checklist for the surgical rules. I think that in itself is a very innovative product. I think when I first learned about it I thought it was really cool because it was something that's really seemingly simple yet really makes a big difference. I went with physicians and nurses who have come by our booth at the conference and looked at the demo of our out. They even said so they're like it's seemingly such a simple idea but it's really important because no the human mind is fallible and so are physicians. So just having a reminder of the vitals that was never never a bad thing. So it's always helpful.

Saul Marquez: [00:08:56] Absolutely and I know we had a guest recently he was mentioning that the innovation in health care is actually implementation. And so when you have a technology as simple as the one that chatter helps provides amnio are the simplicity is what enables that implementation right. And so I think it's pretty awesome that you guys were able to make it so simple.

Joy Bhosai: [00:09:18] Absolutely I think there was a lot of thought that went into the product. So how can we make something a year simple but on the back have lots of powerful in analysis and sort of learning that the user doesn't necessarily have to experience that there's somebody watching the system in place to make sure that that hurt me I think it's been great but I 100 percent agree that implementation is key and health care and adoption because often been seen especially after working with help people know I used to map startups with industry leaders like the big pharma company that Walgreens or what have you. And you see a lot of me come by. But in the end the implementation and adoption and just the pieces missing. I think it's truly important to make sure that your product is usable at a very busy setting. Much of our.

Saul Marquez: [00:10:18] And I had a chance to. Well Sam you walk me through the product and I saw how easy it was to just kind of look through the list and put things out put things make. I mean it was just pretty slick. So now all things haven't been this smooth ride. At one point or another you guys have had some hiccups some setbacks Joy or or Sam either one of you. Can you share a setback that you had as a company and what you took from what pearl.

Joy Bhosai: [00:10:45] Yeah absolutely. We started out. It was back in 2012. Six years ago.

Saul Marquez: [00:10:54] Wow. You guys are veteran in the startup world.

Joy Bhosai: [00:10:58] I back that very first lesson I learned. I started when I was a mouthful. You know it was a lesson that your customer is not always here and there and that help that industry. So whoever buys the product whether it be a hospital or an insurance company or what have you they may have different motivations in your and use their power and how one of her first customers with a big large health system and they essentially know the risk management folks and leadership for super excited about getting this implemented because there has been a few adverse events that had occurred since then when we tried this first met are who are operating are the doctors the nurses didn't see why we needed new things like that. So I think that was a wake up call for me and a very good first lesson that your customer is not always your end the end user. So what we learned from that is to ensure that you get buy in from the user. So we ask that you know the. Yeah the nurses what would you want to see on this screen. How would we better integrate this into your workflow. And after we did that version of the adoption had increased dramatically and people actually this term Mercian who don't even want to start a case without it. So it was a very good question brought in in the beginning.

Saul Marquez: [00:12:32] That's a great one to share and I think one that it's like a lot of entrepreneurs in healthcare run into is even recently I had a friend that started a company to make EMR easier. And he just kept banging his head against the wall because the physicians were the users but the people that actually paid for it was the hospital system and just how do you bridge that you know and it's just a common mistake. Appreciate you bringing that up Joy. So you get this list of things that the clinicians want you create team poll to make those voices stronger and then you give the list to Sam so she could code them all right.

Joy Bhosai: [00:13:13] We have a code and I don't think she code to make.

Saul Marquez: [00:13:23] You got busted, Sam. She codes. This is really interesting. And so from a product development standpoint Sam the codings done do you get back in there and you spend some time in the OR with these clinicians getting feedback on what they think.

Samantha Sim: [00:13:40] So I actually worked a lot with implementation. And I think when you were talking about how implementation really is the challenge in health tech these days I just could not agree more because I think we have a great idea and we have great intention behind it that's great but then implementation of the product and just working with the users we're using is a whole challenge in itself just like what Joy said we did run into we I feel like a lot of companies went into issues that they're trying to launch their product or trying to just implement into big or small health system. And I think a lot of it really was just sitting down and communicating with the physicians the nurses and the health leadership. The health system and see that they're all on the same page and rather than forcing this new product on them just to make sure that we're integrating it into their workflow so that it will be something that's useful to them rather than just another chore that they have to go through. So that was that was the really important lesson I think.

Saul Marquez: [00:14:38] Yeah, for sure Joy would you add anything to that as well.

Joy Bhosai: [00:14:41] No I 100 percent agree. I think the beauty and how it is working and how puck is implementation. I mean I think intentions only get you so far but I think it's the implementation and the results that you see in the end that matter.

Saul Marquez: [00:15:01] Awesome. Yeah totally agree with that. Sam tell us a little bit about an exciting project or focus that you guys are working on.

Samantha Sim: [00:15:08] Yes so one of the exciting projects that have been ongoing that we're still working on is we're trying to implement our products. Internationally. So actually at the conference I spoke to a few facts I spoke to lots of interesting people who came by specially during happy hour when they had a glass of wine and such and they all come out with their new ideas in their words of advice. So that was. But actually I met someone there who told me things like oh no your products are really great and indeed really great in the U.S. But I think they do even better if you implemented internationally especially in countries where patient safety is a big issue or where they have a really large volume with patients and quality doesn't just keep up with quantity of care that they have. So I'll let Joy talk a little bit more about the projects we have coming up.

Saul Marquez: [00:16:03] Very cool.

Joy Bhosai: [00:16:04] Sure. Yes sir we're implementing from the work tools. India actually and the focus of that is to help cardiac care teams especially during cardiac surgery safely do procedures. So the group of doctors that we work with are absolutely amazing their nursing staff is totally competent that they have such high volume where everyone has their volume for fivefold and what you would normally see in a hospital here and there throughput is just phenomenal. And what happens is that no matter how competent a practitioner you are you are poor that many directions all at one time. So they've been using our tools to help make sure that all the steps are done for their patients. Not that they don't know this but just to ensure that everything you know all your teeth are crossed in your eyes are. And that's been really a great help to sort of assist them in doing their best job dirty doing a great job or just their first court. The other thing that I that has been really helpful and I thought about when I tell you to do a lot of work abroad and work in Kenya. I remember on the field days we had been out at a community clinic and it was pointed out to me that a lot of people who are not formally medically trained are doing very small procedures straight part standard procedure simply because the resources are not there. So one of the things that we are really looking forward to it. How can we apply the tools that help in resource poor planning making sure that at their very best there family society guidelines and standard procedures. So how do we make sure that there's good and safe care for people and resource questioning which is really exciting. It's something that I think we'll be working on a bit more in the future.

Saul Marquez: [00:18:04] That is very exciting. So when did you guys start the international work.

Joy Bhosai: [00:18:08] Last year.

Saul Marquez: [00:18:09] Awesome.

Joy Bhosai: [00:18:10] Well I guess in January I guess the year before. Yeah I'm still writing down 2017.

Saul Marquez: [00:18:21] I know I'm still not there yet. We know we still got maybe another week or two before it actually register. Right.

Joy Bhosai: [00:18:27] Right. Just about a year. It's really been something of a priority of mine. What I really wanted to do is focus on getting the module you know in tip top shape where we think that this is a good time right now. So excited to see where that goes.

Saul Marquez: [00:18:46] That is super exciting and especially when you could take best practices like the ones you've developed your whole team has developed and just take them abroad where there's resource poor environments with super towns that people that are being overly burdened with the flow of patients. It just sounds like you guys are going to make such an incredible impact so that is awesome. Good for you guys.

Samantha Sim: [00:19:08] Yeah.

Joy Bhosai: [00:19:09] Thank you.

Saul Marquez: [00:19:11] And so this is the part of the podcast we're close to the end flies when you're having fun. It's been a lot of fun making out with both of you. And so let's pretend we're building a medical leadership course on what it takes to be successful in medicine. It's the 101 or the ABCs of Dr. Joy and Sam. So we're going to go through four questions lightning round style. And so since there's two of you we're going to go back and forth. OK. You'll take Sam you take one, Joy take one right. And so you each get two and then we're going to recommend your books on the syllabus so you guys get to cheat. You get to one book. OK so why don't we kick it off with Joy. What's the best way to improve healthcare outcomes.

Joy Bhosai: [00:19:54] I think understanding process and workflow and making sure that are great when users and how that we experience the products.

Saul Marquez: [00:20:02] Sam what's the biggest mistake or obstacle to avoid making sure that your product is useful and can be practically implemented versus something that's really cool and nifty but not quite useful.

Saul Marquez: [00:20:13] Joy. How do you stay relevant as an organization. Despite constant change.

Joy Bhosai: [00:20:18] Sure involve. Ensures that you have ongoing improvement your product and showing that you're making that and that you always remain relevant.

Saul Marquez: [00:20:28] Love it. Sam what's the one area of focus that should drive everything else in any organization.

Samantha Sim: [00:20:34] Patient safety for us and making sure that that's a priority. So patient safety and quality care.

Saul Marquez: [00:20:41] Awesome. All right. What book would you recommend. Sam go with yours and Joy. Go for it.

Samantha Sim: [00:20:46] All right. I have a very relevant one. So if you guys have not read The Checklist Manifesto by Atul Gawande it's an amazing book and it's really cool because I don't think you'll ever understand how cool checklists are until you read that book and you won't even know it until you read it. So.

Saul Marquez: [00:21:05] A great recommendation. I love it. Joy.

Joy Bhosai: [00:21:09] My hope is that my office here in the giving tree. I love this child's favorite of mine. I just love the way that it is.

Saul Marquez: [00:21:19] That is wonderful outcomes rocket listeners, they have an amazing agenda by two very talented ladies in health care go to that's C H A T R and you'll get all of our show notes as well as the syllabus that we created for you. And the links to the books as well as the profiles for Sam and Joy. Before we conclude I love to just hear a closing thought from both you Sam and Joy. And then just share the best place to get ahold of you.

Samantha Sim: [00:21:53] Thanks so much for inviting. Had so much fun I hope this wasn't too chaotic and an awesome that if there was a lot of talking going on but it was an honor and I hope that a lot of people learned at least a little bit about what we're doing and just the importance of patient safety and the important work that we're doing.

Joy Bhosai: [00:22:14] Yes. Thank you guys for having us here. Really it is great to see you as your community is growing and building upon a great cause. Thanks. So I guess my closing thought would be I really hope that put patient safety on the health communities radar even make it even more present. Like sandblast performances are the leading cause of death and over half the time preventable according to the CDC. I hope there are more folks out there willing and excited to work on it. And we're going to hear from the less you ever want to collaborate on anything. And so to get a hold of it you can e-mail that C H A T R and my email direct email is joy

Saul Marquez: [00:23:07] Outstanding. And Sam is yours sam at

Samantha Sim: [00:23:12]

Saul Marquez: [00:23:15] Oh, full name so and so ok Samantha and Joy this has been so much fun. Listeners again just go to If anything today resonated with you. Reach out. They've invited you to collaborate. And so that's how we do things here on the Outcomes Rocket. We break down silos get these amazing folks to talk about what they're doing. So I just want to say thank you once again Sam and joy for being on the show.

Samantha Sim: [00:23:41] Yeah. Thanks for having us.

: [00:23:46] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

The Checklist Manifesto: How to Get Things Right
The Giving Tree

The Best Way To Contact:

Joy - 

Sam - 

Mentioned Link/s:

Healthcare Podcast

Outcomes Rocket Podcast - Rafael Grossmann

How this Surgeon is Leading the Charge in Digital Medicine and Augmented Intelligence with Rafael Grossmann, Surgeon and Healthcare Futurist

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Outcomes Rocket listeners welcome back once again to the outcomes rocket podcast where we chat with today's most inspiring and successful healthcare leaders. Really want to thank you for tuning in today. I invite you to go to our comes rocket dot com slash reviews where you could rate and review the show and let us know what you thought about today's episode. Without further ado I want to introduce our outstanding guest. His name is Rafael J. Grossman. Dr. Grossman he is a surgeon. Speaker Ted x attendant and speaker exponential Medicine faculty. First Google Glass surgeon the guy has an amazing presence in the digital medicine field and he loves what he does as a practicing physician in general acute care trauma and advanced laparoscopic and robotic surgery. I want to introduce him and I want to open up the microphone so he could fill in any of the gaps of the introduction. Rafael welcome to the podcast.

Rafael Grossmann: [00:01:15] Thank you. So it's a pleasure to be here and thank you for your kind introduction. It's great to be here.

Saul Marquez: [00:01:22] You know it's awesome to be here the first time that I saw your work. I was at Exponential medicine a couple of years ago. You were up on the stage and I could see the passion in your eyes and just in the way that you spoke about just using Google Glass but also digital medicine. So I want to ask you what got you in the medicine to begin with.

Rafael Grossmann: [00:01:42] My father is a surgeon but I don't have too much to do about it I guess shaping my mind down to the level of high school of thought that medicine would be a profession for me the right profession for me I guess I don't want to be too general but I guess helping people you know working with your hands and making a change that you can see those were things that are was attractive.

Saul Marquez: [00:02:09] Yeah no that's that's really interesting and you know it's that heartstring element that gets a lot of us into it. I know that's what sort of got me into it. Rafael but tell me you're deep into the digital realm. What do you think a hot topic that should be on every medical leaders agenda today and how are you seeing it implemented.

Rafael Grossmann: [00:02:29] Well it's a very interesting question and there's so many things you know that we should be using and that we are not using. I mean we we all use computer we all use digital records. Most of us in the U.S. I think that certainly recommend a physician out there every aspiring physicians out there to really research the topic of health being you know from healthcare social media to be engaged culture social media to then things like. Apps things like the advent of virtual reality the advent of augmented reality things are going to change the way we do medicine nowadays you know more and more we use smart glasses more and more we don't want a augmented or artificial intelligence being a helper medicine about robotics we talked about launching that AI and block chain are really going to revolutionize the way medicine is practiced in the next five years or less.

Saul Marquez: [00:03:35] Absolutely. I definitely love your perspective here and one of the things Dr. Grossman is the assumption that people make sometimes you know and I'm guilty of it too. The assumption of hey you know everybody knows what digital medicine is but I think you make a good point. If you're a practicing physician or an aspiring practicing physician the research this area of digital medicine and I think it'll blow your mind away and the other thing that you'll see is that Dr. Grossman Raffael here is pretty deep into it and influencer in the space. And the other point that you made. As you said augmented intelligence which is awesome this concept that AI is taking over us but in reality it's only helping us and you expand on that a little bit more.

Rafael Grossmann: [00:04:17] Yeah it's sort of a terminology that has been catching up is not really artificial. It is but it's really augmented in the actual. And this technology is not to create a parallel system or intelligence that will compete with us. And the same is for many things in digital health. I think that these tools are here to augment us to power to exponentially make us better so that I see very clearly that we human doctors can then it be more better. You want doctors and let the devices that she's applied for use the artificial electronic glasses do what they do best which is you know counting. Remember in selecting a memorizing we are not as good as those systems to do this but we are very good and we should be even better on empathizing and being more human communicating with patients. Maybe wanted more time with each patient but we can certainly get better time with each patient you know computing will not be able to you know hold someone's hands or cry when someone tries not to laugh with someone. Those are things that we are going to be allowed and enabled and empowered to do by you know some of the areas that are better for the computers to handle.

Saul Marquez: [00:05:35] I think that's a really great call out Raphael and listeners there's so much power behind Artificial Intelligence in medicine and it's just being able to understand that without humans that care and health care cannot be provided health can you know you could spray health on people. But it's that empathy that helps bring better outcomes to the table. Rafael give the listeners an example of how you have improved outcomes by introducing digital technologies and medicine in your practice.

Rafael Grossmann: [00:06:04] Well it's hard to prove in a way you know improving outcomes. I haven't done any formal studies in my clinical practice. Again many studies out there and some of them have been involved with in regards to validating oldest technologies to improve what we do and the factual sense in the personal level. I can see how the patients react. I can see how the patients understand better when I explain to them it with the help of an app or when I put some smart glasses on a patient and they can see a hologram of their heart beating for example when I show them on it I'm being watched you recently on a platform using this company any Myra's and we have an arcade platform that is called Insight heart. When you show that to the patient on a smartphone the patient can go around the heart floating in the room and seen the heart beating irregularly. You can see how finally you know this little old lady understood you know what a dreadful relation means that she can get close and die inside the heart and see different. Those are things that are intuitively better and things that are sometimes hard to quantify what the improvement of the outcome I think is just a matter of improving connectivity and communication. Th that's that's the whole goal that automatically has to improve outcomes.

Saul Marquez: [00:07:26] Yeah. Rafael that's a good color. Right. You know being able to communicate with their patients better is as pivotal to outcomes and why you haven't done the studies in your practice per se. You've actually seen the spark in the eye or the acknowledgment of understanding that leads to better outcomes.

Rafael Grossmann: [00:07:44] Absolutely absolutely.

Saul Marquez: [00:07:45] That's great. Give us an example of a time when you guys or you know your team or you have had a setback or failed. What did you learn from that moment.

Rafael Grossmann: [00:07:54] Well you know many times technology is fun when it works and that means you know technology can just tell you and leave you ground or some knew where to begin. Yes I'll have to think back to you know just trying to show someone how cool a an app or a platform and suddenly you don't have internet you know you can me on the Internet. So those are simple things that really prove the point. Wow. Sometimes things don't go as smoothly as they should. And you know there are patients that interest you know patients who you know nothing to do with that with established or with a smartphone just draw it to the to model is not for everyone. Certainly something that is a tool that they can empower us to communicate better and to get to the patients and get the message through much much better.

Saul Marquez: [00:08:43] That's really great. You know and this technology is not for everybody. And when you spend so much time on just trying to impact your patient and make sure that they're better you just have to be flexible. And as you've had many years of experience Rafael in this field if you have to fast forward to the end of your career and you're just the final day and what you do what would be the one thing that you want the health care realm to remember you by.

Rafael Grossmann: [00:09:12] Well I would say that my general idea and my you know motto I guess is that I am all about trying to use technology in a smart way to improve the way we do healthcare and we teach help to communicating and connecting better honestly might jump to fame I guess was the fact that I was the a surgeon who use Google Glass on the training surgery. Yes there was there and there was something very intuitively Don think much about it I just did you know that this cool head mounted camera would be really great to stream a surgeon from the perspective of my the students instead of being right behind me trying to see what I was seeing. They were just next to me you know sipping coffee and answering questions asking questions and having the front seat view of what I was doing. So I thought that that was a pretty simple way to use it but obviously it caught up and it went very very much exponentially viral and that's sort of thing that brought me to before that I don't know you know some text that talks that if we had used an touch back in 19 2011 when the iPhone 4 came out. The iPod Touch to do a teleconference in a basically a daily console for actual trauma. So that got me to do my first direct start to madnesses. But you know in general is my passion is using technology in a smart way to not fancy technology and that's just common technology that sometimes has created gaming. You eventually save a life. So that's sort of the whole concept.

Saul Marquez: [00:10:45] I think that's wonderful Raffael and I think you definitely have left already. You're still early into that early but mente career and you still have a lot of time ahead of you. You've already left the legacy. What are the things that you've done and it's going to be exciting to see what you do ahead here when the years kind of take forward. I'm really excited to keep up with your work and what you're doing. You do have a pretty cool social media presence. Listeners if you're curious you could find Dr. Grossman and Twitter. It's @ZGJR or he also has a website at that's G R O S S M A N dot com. Take a look at what he's up to. I think you'll find it pretty intriguing and it'll spark some thoughts. And I know Dr. Grossman always welcomes communication and chatting right.

Rafael Grossmann: [00:11:37] Absolutely. That's the point to communicate and connect.

Saul Marquez: [00:11:40] Absolutely. So tell us about an exciting project that you're working on today.

Rafael Grossmann: [00:11:45] While there are so many things really the scope of things so basically that I'm more focused than anything else. I've been working on a mixed reality know the fusion between virtual reality and augmented reality for a couple of years. I started using the Hollow Lands Microsoft holographic lenses for almost a couple years. I learned about those early on and then had the chance to try them very very early. When I was a judge in MIT tech had fallen on virtual reality and the people of case Western Reserve showed them to me and then really got engaged. So there was a couple of companies sort of that that I've been involved with and one of them and their medical adviser. One is called Ani Mares. Out of Germany to my view they are really the best NJT WEP illustrator's out there and they do a lot of healthcare and they came up with this pollinates app called Insight heart and I happened to be in the hollow lands working on something and their appertain if I saw it and I thought it was interesting so try it in. It blew up my mind it was just a heart. Very very realistic anatomically correct hologram of a heart that I could manipulate and I could go around and open up. So immediately I give my grade review and I was the first user and the first reviewer of their app that caught their attention and then we connected and then after some time and basically interacting with them we've been having a great relationship and then make an advisory. So we started not just a show in this heart but I really wanted heart to be incorporated into in a way that meets reality seen in the way of opening up manipulating and moving it talking to it and then we started to connect this to censorship that we all were tractors and wearables whatnot. So we started thinking about well we need to see how this art can show not just a being a rate that the artist is giving it but your own heart rate until you started doing that. Yes equinoxes so that that was really pretty cool to see your own heartbeat and then a Arcand out a you know for the iOS 11 and they've been working very diligently. His kids are amazing. Connecting with Apple and Microsoft and a level that any company would just be jealous of. And they came out with inside hard market a module for the iPhone. And it's unbelievable. Everyone should try this. It's you know we sat nav that cost I don't know a dollar or so but it's really unbelievable you can do you can have a floating hologram hard. And it's interactive you compare it with your Apple Watch you have an Apple Watch and you can see your own heart beating or your old rate and with them and you know it's just fantastic is just exponential. Now there's another company that how many of these devices and VDI VHS. It's a Capalaba physicians a radiologist and a neurosurgeon and I met with them that I changed and they have a platform for hollow lens that is unbelievable. It's a platform that really has a whole spectrum. It goes from teaching platform of teaching anatomy. And they also have a platform for the smartphone put in Holo Lens. They go from teaching platform to then a diagnostic platform where you can look at images in a holographic way and interact with them and dynamic way. See in medicine we look at x rays and we look at on flat screens you have 3-D images that we can manipulate on that flask is something different to see the air floating in front of you and you interact with that image and the other aspect is not just diagnostic is therapeutic. You can bring that image and superimpose that image on let's say a patient and then basically potentially enabling a better surgical procedure. So this is all in the early stages. That's the goal. You're going to have these interactive holographic images superimposed in real anatomy and then you can improve what you do therapeutically so it goes from educational diagnostics to therapeutics. I think it's unbelievable. I think it's something that will certainly set the pace of how things are going to be done.

Saul Marquez: [00:15:55] It's so so interesting Rafael and you know one of the things that you mention that going into close to 100 interviews now on the outcomes rocket there's been common themes surfacing and one of the themes that just keeps coming up and hitting us in the head is this idea that in medicine innovation is not necessarily innovation but it's actually implementation of things that already exist that are not being used in medicine. And these examples that you're giving us are just awesome. And to the listeners whether you be a provider or an executive at a hospital or even even somebody at a medical device or pharma company or even a payer for that matter any stakeholder what is it that you can do to implement already existing technologies. Because it's in that implementation that we're going to get some interesting outcomes and able to kind of change the way we're doing things and medicine would you agree, Rafael?

Rafael Grossmann: [00:16:49] 100 percent. No I think that it's really a matter of thinking differently not and I quote Apple's motto Nothing different. You have to think that you have to improve things. I mean you can imagine new things and that's always good. But I think innovate really means disrupting the traditional production and using sometimes the technologies that are right in front of you to improve what you do. In this case will benefit you know use Skype all the time I'm from Venezuela called my family on video. So why not then call our provider hundred miles away or a patient hundred miles away who was in a way that doesn't need to happen you know physically or you know you and I are connected by audio and video and this does not substitute the physical. This is just another tool to improve on what we do communicating and connecting.

Saul Marquez: [00:17:36] I love it. Now that's so true. That is so true. Rafael you're a teacher as well as a provider and an innovator. Let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine. It's the 101 or the ABC of Dr. Raphael Grossman. So we're going to write out a syllabus here. I've got four questions. Lightning round style so I'll ask you give me some shoot shooting answers short and then we'll finish with a book for the listeners. You ready for it.

Rafael Grossmann: [00:18:04] Absolutely.

Saul Marquez: [00:18:05] All right. What is the best way to improve healthcare outcomes.

Rafael Grossmann: [00:18:08] Using technology in a smart way.

Saul Marquez: [00:18:10] What is the biggest mistake or pitfall to avoid.

Rafael Grossmann: [00:18:13] Don't assume anything.

Saul Marquez: [00:18:15] How do you stay relevant as an organization. Despite constant change.

Rafael Grossmann: [00:18:19] You have to think different and not risk failure.

Saul Marquez: [00:18:23] What is one area of focus that should drive everything else in your organization or practice.

Rafael Grossmann: [00:18:28] Looking to the future and having a vision of what the future is going to look like and not be shy to get there.

Saul Marquez: [00:18:34] Rafael what's your all time favorite book that you'd recommend to the listeners.

Rafael Grossmann: [00:18:38] There's so many have there. But I think that in healthcare innovation I have to say that Dr. tarballs but it's really guided me created disruption of medicine and the patient. We'll see you now those are two books that really shape but in medicine in general thing book by Atul Gawande is complications. You by Atul Gawande that when I read it many years ago I called my program director and told him this and every intern for a day or into should need to get these patients and for anyone who's anyone related to healthcare.

Saul Marquez: [00:19:12] Awesome thank you for those recommendations. You know Atul Gawande has come up various times here in this section of the podcast so I think it's time that the listeners if you haven't read including myself I haven't read any of his books. Time to pick one of those up because when the themes are there there's a reason you know these health care leaders are providing us with some guidance. Please take a look at these books that Dr. Grossman offered. And don't worry about writing them down. Go to that's R A F A E L. You're going to find all the show notes with the discussion that we just had today as well as this syllabus that we just put together for you. So dive on and their before we conclude Rafael I'd like to just invite you to share a closing thought with the listeners and then share the best place where they can get in touch with you.

Rafael Grossmann: [00:20:02] Yes absolutely. I want to just mention more when I said I said Do not risk failure I meant. Do not be afraid of failure. You know when you ask me those questions I think that my closing thoughts will be related to the message that will be entertaining. I think it knowledge is here to help us. We should not be afraid of technology. We should be afraid of not using technology in a smart way to do what we do as patients and as providers. I think that the future is really bright. He's up to us that to happen and a communicator and the speaker more than anything else a provider of my passion are my patients and love to connect with people in the social media channels that you mention to them. My website is a non-commercial site that is an educational site. It lists everything I do and everything I learned that I think is interesting or posted there. I am always looking for opportunities to engage physically visually. Conferences to go to. I've been around the world and it's always good to visit places and see what they're doing and learn from people in different parts of the world. You know it's just my honor and my blessing to be invited to do so.

Saul Marquez: [00:21:10] Rafael this is great and listeners just to remind you the Twitter handle is at @GJR and the website is Rafael Grossman with two S's to Visit him. Get in touch. Rafael you contained a lead the way here for providers and digital medicine. So really excited to keep up with what you're up to and so thankful that you decided to join us this morning. Thank you so much.

Rafael Grossmann: [00:21:37] Thank you, Saul.

: [00:21:42] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:


The Best Way To Contact Rafael:


Mentioned Link/s:

Healthcare Podcast

Outcomes Rocket Podcast - Rafael Grossmann

Outcomes Rocket Podcast - Anne Lodge

Why Immune Cell Quality is Key in Personalized Medicine with Anne Lodge, Founder of Astarte Biologics, Inc.

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:19] Alright Outcomes Rocket listeners welcome back to the podcast. Again I want to welcome you and I invite you to go to where you could check out our show reviews and also leave us a rating and review let us know what you thought about today's episode. We bring you the best and that's why we request feedback so that we know our doing so well. Do I want to introduce our outstanding guest today. Her name is Anne Lodge. She's a scientist entrepreneur and she is the founder at Astarte Biologics, Inc. They're doing some pretty amazing things there but really their focus is to provide characterize human cells in animal models systems for study of inflammation and immunity. Their focus is precision medicine. And she's done so many things across the health care continuum for the past 20 years. She's got such amazing credentials from Vanderbilt University just her study in Cell and Molecular Biology. She is truly dedicated to this field listeners and I'm so privileged to welcome Anne to the podcast today. Anne, welcome to the podcast bill and any of the gaps there that I may have missed in the intro.

Anne Lodge: [00:01:34] Well thank you for that very gracious introduction. All I can't imagine what I'd fill in. I'm pleased to be with you today.

Saul Marquez: [00:01:41] The pleasure is ours and we're so glad you carved out some time to chat about your specialty and before we do dive into that and what is it that got you into the medical sector to begin with.

Anne Lodge: [00:01:54] Oh well gosh it's just my curiosity. I think once upon a time I would have been a bird watcher bird looking for a way to get my interest in the natural world with a good career possibility behind it led me to laboratory science and how we can learn more about blackbox we live inside of you know how does our body work and how does it break down and how can we fix it.

Saul Marquez: [00:02:22] Yeah that's really interesting and I love birds too just aligning those interests in ways that help shape and help us kind of build a career. You know it's interesting how we got to make sense of it all. I feel like a lot of entrepreneurs too wanting to get into this space are faced with that reality. You know wanting to put together a solution that they're excited about versus finding a way to fit into the healthcare system in a sustainable way you found the really cool sector of specialized medicine. Give us your thoughts on how leaders today in healthcare need to be approaching this topic.

Anne Lodge: [00:02:57] In approaching personalized medicine. In a sense yes. Yes. I think we've gone from you know kind of the natural progression of science we are now reducing down to G there's there's clearly differences in the human population. We've long studied it in groups you know in assessing how people as a group behave. And now coming to appreciate that she there's an awful lot of individual variation within any group whether it's people with breast cancer or people with an autoimmune disease. There's a lot of individual variability in my own specialty in immunology. The individual variations are maybe more acute because it's all keyed in on very individualized genetic background and that's what has led me into providing human immune cells because they need to be provided as individuals. You can't just pull them together in a more traditional way. So we've tackled that problem so that people researchers can appreciate those differences between individual blood donors between individual immune systems and how individuals respond differently until it's been great to be able to do that.

Saul Marquez: [00:04:14] It's a big deal. And you know you guys have really shaped the way here and given these researchers and labs the opportunity to take these advances and personalized care. Can you give the listeners an example Anne of how some of the work that you guys have done our customers you've served how this has improved outcomes.

Anne Lodge: [00:04:35] So well were as you are probably aware there's a lot of excitement around immunotherapy approach to cancer. So the hurty so the checkpoint inhibitors like TiVo and key Truda having a big impact. So there's a lot of excitement around extending those advances. But clearly there still this that some patients do really well on these drugs some patients don't. What's the difference. And we've been able to look at some of those differences and just to our donor population which is really fascinating to see in the test tube so to speak in vitro tests. You recap that you can see that hey this individual in our experiment response to that drug by orders of magnitude greater than individual why over there where there maybe is a response but it's not that impressive. We've seen our customers are tend to be keep their cards close to their chest but they'll develop a fascination with a particular set of donors and reorder those because they have seen something unique in that individual that may lead us to a greater understanding of the system.

Saul Marquez: [00:05:55] And as we dive into these drugs that are doing a much better job but just don't you just it's not one size fits all. How do providers think about this. How do you put your head together with the deliverer of care and does it look like a test that they have to do a genetic test. What is your vision there what do you think.

Anne Lodge: [00:06:16] Sure. I think that's something that's exactly right is they need more help from. And there are certainly people working on this problem of what's the right biomarker. Can we test somebody and say OK this individual will respond so we can go right to the medication that will work best for them. Yes. Versus somebody else doesn't have that biomarker. Let's try some other approach and that is I think the ideal that many of us are striving for so that you get your diagnosis. And to some extent this is already happening. I think breast cancer is perhaps a good example of this where they can look at the tumor and say gee this will this tumor will respond to these medications and will treat with that. Now if you could apply that model to more more tumors outside of cancer therapy to other arenas where you could apply the right medicine to the right patient. So that would be powerful for the provider to be able to know more and are going to have to go through an experiment here of finding out what the right medication is for you. We're going to run a test and know that this is the right medication for you.

Saul Marquez: [00:07:26] Thanks for explaining that and it seems like there's an opportunity to have a more robust testing mechanism to help providers nail down these things and maybe more to find biomarkers to help.

Anne Lodge: [00:07:41] Exactly.

Saul Marquez: [00:07:42] Got it. So that's really interesting. I can imagine people are working on this right.

Anne Lodge: [00:07:46] Oh yes absolutely. There's great interest and like I said I think breast cancer is perhaps a good example of some of the blood cancers that routinely also have good biomarkers partly because with blood cancers you can get to the source of the problem. In other arenas I think there's just a lot more work to be done to kind of catch up to those example.

Saul Marquez: [00:08:08] Got it. And maybe prevalence is a big factor too right.

Anne Lodge: [00:08:11] Sure sure. Breast cancer is very prevalent but so is prostate cancer. And I think we are lagging behind in understanding which prostate cancers may not be as aggressive as others.

Saul Marquez: [00:08:25] Interesting. Now that's a really good good distinction to make there and you know as a provider you really got to a stop and ask yourself what are we doing as an institution to make sure we're aligning to these practices that can help our patients do better. This is a great example and I recently had the flu and it's nothing like cancer but I'll tell you why I felt so sick. And I'll tell you if I had to feel that way for a long period of time I would want to make sure that whatever you gave me was going to work. And I would be willing to do whatever it took to make sure that what I was going to take was gonna help me in the long run versus just hey let's try this. It might work.

Anne Lodge: [00:09:10] Exactly. I think that is what I really need to recognize throughout the health care system is that there is an awful lot of what we do that benefits maybe 20 percent of the patients and then there's another 80 percent maybe don't get that degree of benefit. Right. If we could understand that better health care ought to be cheaper if you get to give the right drug the first time around and have that the kind of impact you want to have that outcomes. We all we really want to aim towards but to get there we got to study a lot of folks and pool a lot of data to understand how the biomarkers linked to the outcomes and how the drugs interact with that and some of it is just plain going to take time. It's interesting that there has been a test on the market for quite some time that measures the difference in how we each metabolize the drug but it doesn't get a lot of usage and I don't honestly know if that is because it's not seen as delivering the benefit that you would hope for. When I learned of it I said gee we should run this test that measures differences and cytochrome P. 450 G everybody should get this before they get any dogs. You don't like your blood type now and then you know if this person metabolizes fast or slow and therefore you can adjust dosage get it right the first time it's done.

Saul Marquez: [00:10:40] Why do you think that is and why do you think that doesn't get usage.

Anne Lodge: [00:10:44] That I have not had somebody explained to me because I think I raised that to somebody else. We've got this. How come this test it's cleared by the FDA. It's on the market. How come it doesn't get run and I've never gotten a good clear answer. I think it might be expensive. It might be that between the expense and making it clear to providers how to use the result of that test. It's not clear. There are some gaps in there that haven't been properly filled yet. Hey there is a tool that probably needs some help. Somebody needs to pick up the ball and make it clear to providers G.f. here's what you do when you get the results of this test. Totally. Somebody needs to make it clear to the payers hey this could prevent aggrandise of additional expense delays in recovery kind of thing.

Saul Marquez: [00:11:39] Yeah you know and I think this is a great call out and you know something that is all too common in health care. We tend to stick to ways of you know same ways of doing things and if something new innovative comes out it really takes time for to gain traction. There needs to be studies and even sometimes if there's studies it still doesn't even take off.

Anne Lodge: [00:12:00] So if I'm one of those where it just it needs to. You can't just throw it out there and hope for acceptance that it needs some real push in education to kind of say oh this is something that should be part of somebody's medical file and guide prescribing information and such. And I think this isn't just going to be a repeated story across the industry that there are going to be some tests that all will get that uptake that that clinicians will understand it and kind of grab for that and other instances where will these kind of you know it just won't get the uptake that maybe it should get. And so I think yeah we need to put our heads together and get the interested parties at the table and they will see how this can work and make use of it.

Saul Marquez: [00:12:52] And I think that's such a great call out and and listeners you know the thing that we're talking about here is is adoption of technologies that make sense. The point that Ann is really outlining for us is that your solution is not going to work for everybody just like us specific therapy won't work for all patients or specific medical solution is not always going to resonate with all clinicians or all hospitals. So you just got to make sure you tell yourself fine those that this will match most with and run with that and be active in your pursuit because hope is not a strategy. And so you've been at this for quite some time. Can you share with our listeners a time when you made a mistake or failed you know as a scientist then maybe with Astarte today and and what you learn to be stronger today.

Anne Lodge: [00:13:47] Oh gosh well science is built on failure. So yes. And unfortunately there are days where there seems to be a lot of it. As an entrepreneur I think by one regret that I have is that I turned away from the business for a couple of years and I was fortunate to find some business partners to kind of take it on and help it to grow for a while while I went got another job. I think in hindsight I would have hung in there longer and found a way to stay with the business for a couple of years. I was sort of a silent partner and missed an opportunity to kind of experience that part of the growth process make some different decisions or even dissipate the decisions that were made in a more active way. So I think if I had it to do over again I would have stayed I would have eaten more peanut butter and jelly and ramen right whatever ramen could do really good. Ramen is still good whatever it takes. Because if you believe in what you're doing you really should stick it out.

Saul Marquez: [00:14:56] That's such a great great pearl there. And listeners reason why we asked the why. At the beginning of each show as to dig deep and to understand what the passion that drives you to do what you do because if you have that clear of that is always resonating and you just feel the punch of that every morning you wake up as without a doubt you'll stake your course and and and definitely is feeling that now and she's moving forward that that's why she's fully engaged in her company. Some pretty cool things going on there. Astarte and educated me before we got on the show is a mythology goddess that is revered for her things and in war and in love and in leadership. And so this name you guys I encourage you all to check out what they're up to at will provide that link in the show notes. But and let's dive into this a little bit further. Give us one of your proudest medical leadership moments that you've experienced today.

Anne Lodge: [00:15:54] Well I would have to say you know we were able to help one of our customers clients develop a new test for their drug. It was a really intellectually satisfying project to work on. It involved an area of immunology that that has always interested me and very interesting drug that is on the market helps a lot of individuals with multiple sclerosis. So learning more about that drug and how to test it to make sure that each batch manufactured is consistent. It's a very complex treatment or drug if you will it's really a mixture in that little bit black box. And we were able to learn more about that how we could test and ensure that it was the same thing coming out the end of their manufacturing process each time and they patented that and I was named on the patent. And that's kind of a pleasure. It's a funny thing. I won't make any money off of that but it's still Marko's. Hey this is a this is a new idea that a group of us came up with and we were able to reduce it to practice. And that's kind of a cool thing.

Saul Marquez: [00:17:05] That's a really cool thing. And and you've baked in your history there and helping patients with multiple sclerosis and sure that they have a safe delivery and effective delivery of care right.

Anne Lodge: [00:17:17] Yes yes.

Saul Marquez: [00:17:17] That's big. That's that's a lot to be proud of. Congratulations Anne.

Anne Lodge: [00:17:21] Thank you.

Saul Marquez: [00:17:21] So what would you say an exciting project that you have going on right now.

Anne Lodge: [00:17:26] I'm really excited about our line of antigen specific T cells T lymphocytes are really an army of disease fighters but the thinking about this army is that each soldier if you will each so is directed against a different enemy. So you're happy souls that will attack the flu virus you have t cells that will attack Epstein Barr virus that causes infectious mono and so you have all of these different types out there. They're very rare individually so if I was to look for those cells that fight off the flu you had yes they'd only be present in like one in 10000 of her lymphocytes kind of rare facilely were were enriching those and providing more purified or more enriched for whatever you like. You know out there or whatever you want. So we have cells against the flu. We have cells against Omega virus you know different viruses at this point and we're going to launch one that is specific for a tumor antigen called gabion T1. So theoretically our product is only meant for research but there are those that are working on developing a treatment where you would infuse tumor specific T cells and fight off the cancer that way. So fascinating studies are going on. We're doing the research corollary of that so that people can look at them and say okay what makes it effective versus maybe ineffective. So we think that these will be useful tools in learning how to manipulate that part of the immune system.

Saul Marquez: [00:19:07] That is so fascinating.

Anne Lodge: [00:19:09] I kind of had a vision of gee there are all these companies that sell different antibodies to everything you can imagine.

Saul Marquez: [00:19:16] Yes.

Anne Lodge: [00:19:17] And antibodies monoclonal antibodies are very widely used tool. They've been invaluable to me. I think we could do the same thing with T cells and they would be the same but different kind of tool and the types of different cells we could make would be nearly endless and would help us as you know understand that part of the immune system and how we can use that more people help for Cancer Immunotherapy or in the opposite direction. How do we tone those down so that celiac disease and rheumatoid arthritis are controlled better now and harder.

Saul Marquez: [00:19:53] So Anne, just for the sake of a simple example if you have five t cells in your body only one of them say would fight cancer. And the other four stay dormant because they're not the ones that would be activated yet.

Anne Lodge: [00:20:07] They're not the right ones. They don't match.

Saul Marquez: [00:20:09] And then what you're suggesting is you would help populate the T cell with more of its soldier types so that it could fight the disease faster.

Anne Lodge: [00:20:19] Correct. Yes. More soldiers do rabbits regens whatever it is easier they're fighting it.

Saul Marquez: [00:20:24] I think that's such a such a very interesting idea.

Anne Lodge: [00:20:29] Well I think met with a researcher from the University of Washington and we kind of joked about here's what we have to do and actually nature has already done that. How do we make nature do that on cue. Right. Right.

Saul Marquez: [00:20:43] That is fascinating. We recently interviewed a guest who is a specialist in Kombinat Tauriel biology and he was talking about the amphibian kingdom and how these animals can regenerate even organs.

Anne Lodge: [00:20:58] Yes.

Saul Marquez: [00:20:59] Why can't we, entire limbs if they can regrow a leg.

Anne Lodge: [00:21:04] Why can't we. Right. It's like well sure why not.

Saul Marquez: [00:21:10] Because we need to be asking.

Anne Lodge: [00:21:12] And these are the questions we need to ask and not laugh because they sound like they came from a 6 year old. I think that it's a reasonable question why can't we do that. Oh yeah. When you're out. How does a frog do it so that we can trick the human into doing it.

Anne Lodge: [00:21:27] There's a genetic program there. It's there in the DNA. We just need to trigger it somehow. That's right. Yeah. And this is not your world. It's not just regenerator. There are so many veterans that have lost limbs. Can you imagine if they could have those limbs back.

Saul Marquez: [00:21:44] Unbelievable. It would be a dream.

Anne Lodge: [00:21:46] Yes. That's what science is is a great place for dreamers like me and I guess you had that wondered why can't we grow a new limb.

Anne Lodge: [00:21:54] We should wonder those things and then pursue those wonders and find out more and through that understanding when we may be able to perform that kind of wonders.

Saul Marquez: [00:22:04] Well I think it's so cool. And and you know what you guys are up to add a star to biologics your theme of let's discover together is so in tune with our belief here at outcomes rocket where hey we've got to break down the silos and discover together. Let's help improve outcomes together in that spirit and I want to invite you to build a medical leadership course with me today. It's the 101 or the ABC of Dr. Anne Lodge. And so this is going to be four question lightning round style. We're going to put a syllabus together for the listeners. We're going to finish that syllabus off with a book that you recommend to them ready.

Anne Lodge: [00:22:44] OK.

Saul Marquez: [00:22:45] All right. What's the plan. I love it. What is the best way to improve health care outcomes.

Anne Lodge: [00:22:52] Understand individual differences. What is and the patient being treated.

Saul Marquez: [00:22:57] Love it. What is the biggest mistake or pitfall to avoid.

Anne Lodge: [00:23:00] Lumping people together.

Saul Marquez: [00:23:02] How do you stay relevant as an organization. Despite constant change.

Anne Lodge: [00:23:06] A relevant is staying up with the change. God there's an awful lot to stay up with but that's what makes it work.

Saul Marquez: [00:23:13] What is one area of focus that should drive everything else in your organization.

Anne Lodge: [00:23:17] What can we learn.

Saul Marquez: [00:23:18] What can we learn. It's a great question and then that thought process what book would you recommend for the listeners so they could learn more.

Anne Lodge: [00:23:26] You know this is a tough one. And I've read some good you know but I've got to say I love the late Oliver Sacks who wrote beautiful pieces about individual patients and what their experience of their own illness or handicap were and the amount that he could learn from one individual about a particular the disease they really came through in all of his writings. So island to the blind I think it is called or the man who mistook his wife for that's a good one.

Saul Marquez: [00:23:59] All right. This sounds interesting.

Anne Lodge: [00:24:02] Yes exactly. So all of his or many of his books were about mistakes of perception of our senses feeding us the wrong information. So I think there's multiple levels you can enjoy. And his writings both from a health care perspective of talking to the patient understanding patients which he clearly did throughout his career. And also what we can learn about our own perception and how we can be led astray by our own perceptions are kind of cautionary tale.

Saul Marquez: [00:24:32] And while I love it and such a great recommendation and listeners don't worry about writing this down just go to That's a n n e l o d g e. You'll be able to get this syllabus that we just put together for you. A link to Dr. Lodge's company as well as all of the resources that we've mentioned through our Q and A today on the interview. So before we conclude an I love for you to just share a closing thought what the listeners and then the best place where they could get ahold of.

Anne Lodge: [00:25:05] So closing thought I think is that we should all share our perspectives on personalized medicine from whatever area of healthcare that we work and work together to improve outcomes for all patients and where they can get a hold of me is probably go to a Check out our phone number. There are a small group call him and if I have time I'll be happy to talk.

Saul Marquez: [00:25:31] Well there you have it listeners an invitation to reach out and phenomenal interview today with Anne and really appreciate you taking the time with us and today and and for for providing this inspiration to think beyond the conventional to improve outcomes so really want to thank you again for making time for us.

Anne Lodge: [00:25:50] You're very welcome, Saul. Fun conversation to have with you.

: [00:25:57] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

The Island of the Colorblind

The Best Way To Contact Anne:

Call Astarte Bio at  866-513-1894

Mentioned Link/s:

Healthcare Podcast

Outcomes Rocket Podcast - Anne Lodge


Social Determinants of Health

The Reality of Social Determinants of Health with Rajib Ghosh, Chief Data Officer & Chief of Transformation at Community Health Center Network

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host Saul Marquez

Saul Marquez: [00:00:19] Outcomes Rocket listeners. Welcome back once again to the outcomes rocket podcast where we chat with today's most inspiring and successful healthcare leaders. I really want to thank you once again for tuning in. And if you love the podcast go to and leave us a rating and a review on Apple podcasts through that link. I love hearing from you all. It makes my day when I do here so please take the extra minute and leave us a rating review if you enjoyed. I want to introduce an outstanding individual and our guest today. His name is Rajib Ghosh. He is the chief data officer and the chief of transformation at Community Health Center Network in San Leandro California. He's done a lot in health care. He's also in O and C health I.T. fellow and I could just go on and on about this amazing person. But what I want to do is just welcome Rajib to the podcast and Rajib if you don't mind fill in any of the gaps in the introduction.

Rajib Ghosh: [00:01:23] Sure. Thank you very much and appreciate the opportunity to be part of your podcast. My career is almost now about two and a half decades. I've been in various places in the last 13 years of those I have spent in health care focused in health IT. So I have done product management product launches working for large organizations small startups providers payers so you name it. I kind of like to cover everything in the healthcare landscape except one thing I haven't worked on pharmaceutical so yet in my career.

Saul Marquez: [00:02:03] Oh I heard yet.

Rajib Ghosh: [00:02:04] You never know. Right.

Saul Marquez: [00:02:08] That's true. That's true. You can't limit yourself.

Rajib Ghosh: [00:02:10] Yes.

Saul Marquez: [00:02:11] That's great. Well Rajib thanks for that fill in. You know it's you've done a lot of really interesting things. You've worked on the provider side. You've worked as a consultant. You've been. You started a company. You've done so many cool things. And my question to you is why health care why did you decide to get into healthcare.

Rajib Ghosh: [00:02:31] That's an interesting question. So my career started as a software engineer writing software or telecom industry managing huge data sets and then later I worked as a consultant. As you said in large scale industries like publishing to transportation manufacturing. Thirteen years ago I moved to health care inspired by some work that one of my friends. At that time this company was doing in healthcare. So healthcare technology and opportunity to make this impact in the lives of millions of people in the nation and also worldwide is clearly became quite fascinating to me as I started to learn about the industry. Since then I've worked in many technology vendor companies for evil corporate monitoring Twitter Amaar for the Labor and the delivery department in a hospital. Later a move to the chronic disease management space what I learned about the increasing disease management burden the chronic disease burden that the world is facing or will be facing in this century. And that is quite inspiring that some of the work that I did in the Telehealth, telemedicine space can have a major impact in around the road in facing this challenge and this is a worldwide issue. So that also makes a scale very interesting the opportunity to help providers and patients with technology like that. This is quite fascinating. So it's also the fact that I'm interested in the health policy side I'm really fascinated by helping the clinicians really do what they do best which is really taking care of patients and that is really fulfilling inspiring and then gives a purpose to the work that I do. And I think that is really important. But also I love the intersection of the health policy technology and the care delivery the operational processes because what I understood in my career so far is that if you're in healthcare you have to understand the implications of this and if we don't because then we can be in that business because there's so much dependency on the health policy world. And I think that's what makes my job really interesting and inspiring every single day.

Saul Marquez: [00:04:51] Rajib. You're fascinated by health care. You're intrigued by policy and you're knee deep in I.T. right now. What do you think should be on the forefront of medical leaders minds and how are you guys addressing that where you're at today.

Rajib Ghosh: [00:05:07] So there are many things I can think of actually but in a couple of things they wanted to mention as a human race we're really on the cusp of a new phenomenon which I call is a century of longevity which we have seen as a race ever. So this is going to be our first step into that fight which is exciting. Yeah it is exciting. It is definitely exciting but also because of the fear of the unknown. We don't just don't know whether they're right. Collectively we are going to live longer than the previous generations. And that's a fact. So this also means that the burden of these chronic diseases will continue to increase worldwide. This puts a lot of stress on the caregivers community both the family caregivers as well as professionals left for missions that is going to increase. And that is going to lead to more caregivers or not. This is already started to happen in the physician's community where we are seeing major burnouts in there. The rate is actually in wheezing. So this should be on the agenda on all healthy Obama's hands including the government agencies. There is another aspect which is also making the century quite interesting which is we are waking up to this new reality that social determinants like you know housing situations the crowd station the food the isolation other behavioral aspects are connected with that and then play a big role in determining a person's health. In fact with the numbers that I've seen is like health is 10 percent of the health is really medical. Is everything else. So that is something to ponder. So how do we integrate all those data from those myriad of sources and turn awful analytics on that to continue to be on the agenda that should be on the agenda of the city and the county and the state level and then. So this is this is really a bigger things to tackle. Just to give an example in California there are right now 18 state funded they call a whole person care pilots accrued last year to tell a nice sunset. And you know over a five year period. But I think this is a really good beginning. And that is definitely on my agenda among organizations again that we are deeply integrated with some of one of the county's pilot programs to really drive some of that. And I think that should be on the agenda of other organizations as well.

Saul Marquez: [00:07:34] Rajib is this a California sponsored program.

Rajib Ghosh: [00:07:37] It is a California sponsored program Yeah yeah.

Saul Marquez: [00:07:40] I love that. I think it's it's really interesting right. You mentioned two things here. We have the potential to become centenarians and it's very real and the comorbidities and chronic diseases that need to be managed are going to increase. And then on the other hand the thought of that goes along with it the social determinants of health. It's a shame that at this point the incentives are aligned in such a way that we're not incentivized to tackle those. What are your thoughts there on how your organization is doing it to stay aligned to incentives. At the same time look to where the puck is going.

Rajib Ghosh: [00:08:19] Yeah. So this is something as I said you know payers and providers are kind of beginning to just waking up to this new reality. So it's going to take a little bit of time and I'm already seeing movements happening in the air war where they are acknowledging that fact that if a patient discharge from hospital can go to the primary care practice because the person didn't have a transportation to take the person back to the family clinic. That person is going to end up in the E.R. room pretty soon. And so that's a high cost which can be avoided by just making a twenty dollar override sponsor that is with our patient. Right. And I think this is a conversation that we are having with our peers that we work with and they are listening. They're not. It's that they are not listening. I think the key challenge is anything in healthcare we want to see that what is the only the longer term impact. Show me the money. Show me the value first before we adopt it and some of these things you know may sound biting. Tweet it to us when we talk about it when it comes to really paying for it. I think the CFOs of the war they will like to see a bottom line. And I think that is really the challenge. My personal feeling is that we will be sewn into this especially with these pilots which I hope will prove great results which show to the community that this thing should be funded there should not be any debate about that. It is a standoff.

Saul Marquez: [00:09:53] Yeah that's really interesting and kudos to you guys for getting involved in these pilots. The whole person pilot you called them.

Rajib Ghosh: [00:10:00] It's called whole person care pilot.

Saul Marquez: [00:10:02] That whole person care pilot will definitely have to take a look at that haven't heard about those very intrigued. Thank you for sharing that.

Rajib Ghosh: [00:10:10] No problem. And please take a look at it and you will see a very interesting very very interesting program outlines that different counties effort together. And there are some are not counted and some are really building else. But yeah that's very interesting I'm really excited about that.

Saul Marquez: [00:10:27] Yeah me too. I mean that sounds fascinating. So can you give us an example Rajib of how you guys have used some of these pilots or or maybe in another area that you've worked in that you've created results are improved outcomes by doing things differently.

Rajib Ghosh: [00:10:44] Sure. I mean there are many examples. I mean we are among this makes me feel proud about privatization that we are quite innovative. We don't have lots of resources but we try to innovate as possible. So let me be one example which I think actually produce tangible results. So we offer as part of the organizations we do have provided for the delivery centers but we also have a managed business and we manage about 140 thousand manage our lives in one county Alameda County where we are we are based. And we take full probational risks on behalf of our health centers working with two Medicaid health plans that are operational in the county. So what is important for this health plan is that overall performance ratings for the state. And that is determined by some measures called ETUs measures. For those of you and your listeners who don't know that term it means healthcare effectiveness data and information set is really a quality metrics in a way that was 81 homes and all of those 81 measures are tracked by the state and the planes get their star ratings based on that. So healthplan Pushto organizations provider organizations to help them improve those costs by delivering better and timely preventive care for example cervical cancer screening or immunization a time when they zation are the appropriate level of HIV and control and stuff like that. So the better scores allow what health centers to be set up a focused health center that the plans would make to do work with a business with help us from the managed care standpoint to really negotiate better contract rates for different services. Two three years ago our county and our health centers didn't do very well in fact we are at the bottom in terms of the state level for the last one to one and a half years. We relentlessly stayed focused on conducting better analytics to identify the gaps in care for all the patients that are seen around centers so that allowed our health centers to do timely outreach bringing patients to the clinics for the necessary preventive procedures and then really address the possibility for any kind of a disease exacerbation of passion and what you're seeing is that over this time we have made significant improvement in the ratings and we are now among probably ninetieth percentile still some way to go I think. But you know obviously we can do better. But it's actually a significant improvement. And that is also possible because we change the approach. You know we look at the data we look at the analytics. We took the action plans we implemented them followed up on them and those things.

Saul Marquez: [00:13:38] Well congratulations. I mean a year and a half and now you're in the 19th percentile.

Saul Marquez: [00:13:43] That's awesome.

Rajib Ghosh: [00:13:44] Yeah. And a proud moment for us.

Saul Marquez: [00:13:47] Absolutely and you know those kinds of things don't get down overnight. And you said relentless focus. You know that relentless focus listeners is is really what is necessary to create better outcomes and better results. There's so many things that you can focus on and how do you decide which ones you're going to pick and which ones are going to give you the results you're looking for the improved outcomes once you decide on those focused relentlessly like Rajib did and his team and you'll create those results. Rajib Can you share one of your setbacks in healthcare and what you learned from it.

Rajib Ghosh: [00:14:27] Yeah and I think you know I personally feel like that you learn more from said.

Saul Marquez: [00:14:33] Totally agree.

Rajib Ghosh: [00:14:35] And also it's an innovative organization. The other philosophy that they follow that it's better to fail often and fast enough and lean start up sort of a model because the fear of failure isn't really a big barrier to make advances right. So with that said there are a couple of situations they can think of where sort of. You know I think the judgment that we've made that I've made failed to produce the desired outcome in a timely fashion which could be disappointing but there's a learnings there. So when I started my current job when I came into organizations I felt the need to really develop a very robust data analytics infrastructure because I feel like that is really the recipe to provide better care and efficiency and stuff like that. So in absence of that our data analyst that we have no organization felt that a lot of time is being spent on mundane stuff. And that access know cleansing that have been building it for analysis was just really doing it quickly and giving actual plans to the health centers or the frontline staff. So being passionate about that about data analytics I thought this should be sort of a slam dunk or our health centers to really they will buy into this. And my organization. We can all work together. Start in again. Structurally my organization is a network of musicians. That means that all the health centers are independent entities but they are midcourt with us. And then we set up the next level. So I crafted a big vision of building interfaces a lot of infrastructure using it and let its program and that iPod that you know health centers will come with these cases right. And then we can show that hey you know what for. This is why this is and generates quite easily for you. But to my surprise it didn't turn out to be that way. As you know health centers werent had many pinpoints that they were aware of that where they could see that that infrastructure investment and deeper analytics could be savvier for it just like you know the payment reform was on kind of on the brink of happening didn't happen yet and a lot of fee for service going on an incentive driven payment models are sort of discussed being discussed but not so much tangible. And also the sharing data to centralize analyzed data was was also a contentious issue. This is the reason why they cherry model is is also pretty difficult and you know not enough just on the public sector or even on a private public relationship. So the key lesson learned. I mean it took us a while to really bring all the parties together and that didn't meet the sort of the timeline that I had. And so in a way that vision really didn't want the way I wanted to. But the key lesson learned is that not this kind of a scenario takes a lot of persuasion before even beginning to execute such an initiative. And that is the reality of today that it takes a lot of persuasion because a lot of stakeholders involved and all those stakeholders have their own reasons not that they are just playing politics but they have their own reason and we have to build this cohesion and this collective work together collaboration model you know pluralism is difficult to say. So you know the general tendency of human beings and organization is to be tribal and autonomous and then so that's a lesson learned that it takes a lot of work that needs to go in before we can start building a model of even if it's for improvement. But it takes a lot to do that.

Saul Marquez: [00:18:24] Now that you and I appreciate you sharing that story Rajiv So now that you fast forward to today. What would you say the best way to do that is how do you prime the environment that you're in to accept a change.

Rajib Ghosh: [00:18:38] I think the change needs to be introduced in depending also on the organization. But in healthcare change needs to be introduced slowly and thoughtfully. That's one of the things that I often talk about to my industry peers and startups and all of that is we talk about many times we talk about especially in the Silicon Valley that we wanted to disrupt disrupting healthcare is not necessarily the best thing that we can do. I think we can work together to make it better. And there are many ways to do that. So this is example with he said that if we wanted to disrupt a model where things are being done very very differently and they are not used to it. I wanted to enforce something from outside just because I have an experience of doing it somewhere else outside. Outside of healthcare Sadly the chances are it's not going to be embraced. It's not a war it's going to fail. So health care is a very strange animal. And that's the reality and we need to work these changes through with managing change every step of the way and really building this cohesive relationships and trust which will eventually produce results.

Saul Marquez: [00:19:52] Yeah that's a great feedback there. And so Raghib tell us a little bit about an exciting project our focus that you're working on today.

Rajib Ghosh: [00:20:00] Yeah so one of the very exciting projects that we are at the moment working on is we wanted to see how we can bring all our health centers which are on different ph our system into a common electronic system because what that will do us is that then we can launch various other services which are more of a virtual care services. We take it as a virtual care like telehealth telemedicine in a very consistent and cohesive way. So that's how you started how the finished where you captured information. How do you get a break here. How do you identify the patients who Hofstetter would be amenable for a virtual care delivery model. How do you integrate behavioral health into primary care. So all those things can be achieved in a scalable way. If we can't have a single system across all overheads so that's really one of the projects that is actually a big initiative a very strategic initiative at the same time but it's ongoing and you know lots of challenges. Again same thing that I mentioned before building this trust building this cohesion building this common vision. But I think when one storm I think this is going to give us some tremendous hit Tippee believe me to do things in a scalable way in a quick and easy way. It's good for the community overall.

Saul Marquez: [00:21:24] Now that's really interesting. Yeah and what type of timeframe are you guys slotting out to get this done.

Rajib Ghosh: [00:21:29] You know a product like this takes a minimum couple of years to really lifted off the ground and make it operational. I think the key thing is building a sort of a common strategy common vision and that is what we're focused on right now and why didn't you find some partners who wouldn't be the real players and also the sense of identifying the funding sources and I think that's as critical as crafting provision.

Saul Marquez: [00:21:56] I love it. That's awesome. All right. So right now you and I are going to pretend we're building a medical leadership course and what it takes to be successful in healthcare I.T. today is the 101 course or the ABC of a Rajibo Ghosh And so we're going to write out the syllabus and ask you for questions is going to be lightning round so we're going to get some quick responses from you. And then you'll recommend a book to the listeners at the end of the syllabus. You ready. Yeah. All right. What's the best way to improve healthcare I.T. outcomes.

Rajib Ghosh: [00:22:32] The best way to improve healthcare I.T. outcome is to make all the data interoperable which is the big barrier right now and actually drive the outcome.

Saul Marquez: [00:22:44] What is the biggest mistake or pitfall to avoid.

Rajib Ghosh: [00:22:47] The biggest pitfall to avoid is for from a medical standpoint is not focusing on prevention as a best way to prevent chronic disease onset of diseases that could be prevented or delayed.

Saul Marquez: [00:23:02] How do you stay relevant as an organization. Despite constant change.

Rajib Ghosh: [00:23:07] Our entire focus in our organization is to help our patients for all their needs whether it's behavioural medical social. And that is the mission that drives us. And I think as long as we stay focused our health I.T. initiatives and technologies not all of them are going that direction. And we have relevant communities that pay.

Saul Marquez: [00:23:28] And what's one area of focus should drive all else in your organization.

Rajib Ghosh: [00:23:33] I think the main focus area right now is how do we integrate social and medical together into a common framework and demonstrate outcome for managing that.

Saul Marquez: [00:23:45] What book would you recommend to the listeners Raje.

Rajib Ghosh: [00:23:48] Okay so the book that I will recommend it's not a medical book but it is a very good book that I had recently it is a book by Tom Friedman the famous author of The World Is Flat. It's called Thank You For Being Late. The thing that I like about it is it's an excellent reflection of what is happening around us and that's it for us in health I.T. medical professionals to really understand the Good the Bad and The Ugly that's shaped by these exponential rate of change in technology business model human interactions and bondman or ethical changes. Pretty much everything. And the author has asked us to take a moment to ponder how nature has designed the eco system that are intricately dependent on one another through meaningful interactions and that's how we have sustained ourselves against the force of change for millions of years. And I think there are some lessons that we can take from that and how we can work together collaborate. Technology medical clinical social come together for one single thing just to really achieve Sapyta out or all of the.

Saul Marquez: [00:24:55] And that's a great recommendation. Rajiv and listeners if you want to go get a download of all of our show notes as well as the syllabus to this course that we just constructed for you and the book a link to the book linked to Rajib's organization. Just go to That's our RAJIB and you'll be able to find it there. But before we conclude I just want to ask you to share a closing thought. And then the best place where the listeners could get in touch with you.

Rajib Ghosh: [00:25:27] Sure. As I mentioned before that we are living in a very exciting time in the age of technological exploration advances in technology are happening in leaps and bounds which are impacting everything every industry including healthcare. We are also going through a period when our physician community are experiencing increased rate of bore outs. So those are two key things. While we in healthcare we focus on patient satisfaction cost and quality of care. We can't forget that we need physicians strategically for that care. So despite having all kinds of technologies and all the apps platforms Wardle's machine learning artificial intelligence and now block chain. But at the end physicians still play the role of the Mealer so that empathy of a physician towards the patient often is this the real elixir. So in certain disrupting healthcare we shouldn't forget that we should strive for quadruple aim that is physician satisfaction as well. So that's closing thought.

Saul Marquez: [00:26:27] I love it. Rajib where kinda listeners get ahold of you if they wish.

Rajib Ghosh: [00:26:31] I have a Twitter account. I know the handle is @ghosh_r. My last name is ghosh sh underscore are your listeners can also send me a connection invite on LinkedIn and you can look me up on the link above with my name and also I write a regular column on health care analytics on a publication called which is published by monthly so I request soullessness to follow my thoughts there if they want to and if their interesting ideas. They said that they would like to share with me and I'm always interested in hearing that if they can use better sounding board or needs more advice if they want to. And at no cost and they can reach out to me they are linked in first and then I'll provide for information as there are.

Saul Marquez: [00:27:23] Awesome Rajib, listeners they have an invitation from hajib to collaborate to check him out on his blog posts and just get in touch in general Rajib. I just want to say thanks so much once again. It was really fun having a conversation with you and looking forward to staying in touch.

Rajib Ghosh: [00:27:41] Thank you so much. And once again thank you for having me on your show.

: [00:27:48] Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Thank You for Being Late: An Optimist's Guide to Thriving in the Age of Accelerations

The Best Way To Contact Rajib:


Rajib Ghosh

Mentioned Link/s:

Blog -

Episode Sponsors:

Healthcare Podcast

Social Determinants of Health




Outcomes Rocket Podcast - James Glinn

Improve Productivity and Increase Access to Care while Making a Difference with James Glinn, Founder, Movement for Life

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:19] Outcomes Rocket listeners welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring healthcare leaders. Hey I really want to thank you for tuning in and I invite you to go to outcomes rocket dot com slash reviews where you could rate and review today's episode. Let us know what you thought about our guest today. Let us know what you think about the show in general because it really makes a difference. We love hearing from you. So give us that surprise give us that joy. Without further ado, I want to introduce our outstanding guest. His name is Dr. James E. Glinn. James Glinn is the founder of Movement for Life team as part of an amazing group of people and dedicated team of experts Dr. Glenn contributes to the advancement and operation of the largest employer own fitness wellness and outpatient rehabilitation team in the United States. In addition James is currently passionate about tele movement a nationwide wellness and physical therapy directed platform network delivering curated evidence in real time. He believes that movement is a core piece of health when not striving to improve the lives of those he serves. James is a former All-American swimmer enjoys surfing paddling and other water sports as well as spending time with his lovely wife and daughters gym. I really want to welcome you to the podcast today and then have you add anything else to that intro that I may have missed.

James Glinn: [00:01:51] Oh goodness. A burst of joy. It makes me sound great. Thanks so much for having me.

Saul Marquez: [00:01:56] My pleasure.

James Glinn: [00:01:57] Anything else to add. There are so many pieces to add you know as says movement being a big piece of health is really important and everything that we do and so I might add is you know recently we've been doing some work in St. Louis County with the public health department and looking to see how we can integrate movement as a key component for healthy communities and get healthier people so I'm really into this concept of health and health care truly being a local thing and very difficult in many ways to outsource.

Saul Marquez: [00:02:30] I think that's such a noble cause that you're doing their Jim and the end of the day you know you've been an accomplished entrepreneur and contributor and health care. Why not give locally and and kudos to you for taking that dive.

James Glinn: [00:02:44] Oh really well thank you. And the beauty of contributing locally is we all are members of our local community and so we all benefit from our contributions and so that concept of collaboration and what's possible and all worked together is just so critical for I think what's possible in healthcare as.

Saul Marquez: [00:03:01] So true. So why did you get started in the medical sector.

James Glinn: [00:03:04] So since I was a young boy I've always been around the health care sector. My father was a physical therapist in the hospital so I spent weekends yes tagging along with dad and being in the hospital. And from a young age it was really instilled in me that serving others is one of the options that we can take for our career and for our life. And that really that really struck me the concept of serving others and selfishly there's nothing i'd rather rather be doing.

Saul Marquez: [00:03:32] That's so cool and sounds like your dad blaze some trails there and you've done an amazing job just you know follow in his footsteps and in your own way. And so here you are fast forward to today. Many years have gone by what do you think Jim a hot topic that should be on every medical leaders agenda today is and how are you guys addressing it.

James Glinn: [00:03:54] Well it's the possibilities right this idea that we can innovate further and health care. There's there's so much low hanging fruit and health care. I think every medical leader and goodness you know we all I think of unfortunately or fortunately have to serve as our own medical leaders so that's on everyone's mind I think is what health care looks like. What are these roles and responsibilities. Because there's so much more that we can do and say there's so many inefficiencies. So figuring out with each other how we can collaborate for the benefit of the patient you know with this patient at the center of it is is really an exciting opportunity you know so for my field if you consider in my field of physical therapy which I think is just this fantastic field where the care that we deliver has few side effects. Roughly 7 percent of individuals with health insurance. So you know that number goes down even from their access to physical therapy services. And so that's just an illustration of something where we can make big change I think by sharing information and collaborating together so you know us what we're working on what we're working on right now is partnering with the Journal of orthopedic and sports therapy to take some of the clinical practice guidelines and make them more accessible for everybody. And we're doing that through our platform which is called and we just launched that a little bit ago after literally decades of talk about what might be possible. I mean really I know we're fired but we're really excited about the possibilities a movement being efficient in this back and really making some changes in healthcare.

Saul Marquez: [00:05:25] I think that's great. Didn't know that statistic was so low 17 percent of insured people have access to physical therapy. That's pretty crazy.

James Glinn: [00:05:34] Yeah it's just a real low access. And even those that do get you know you have to imagine some of the challenges of accessing certain parts of care. And this isn't unique to our profession or our specialty per se. You know there are all sorts of other access issues in healthcare from primary care as well as the services just living locally.

Saul Marquez: [00:05:54] I guess I just had never thought about that segment of physical therapy being solo I think you know you think that it's something more widely used. But yeah very interesting stat. Thanks for sharing that. So give us an example Jim of a time when you guys created results by doing and thinking differently.

James Glinn: [00:06:14] Well there is what we have thought differently and essentially we only started this way is that on our team because we're healthcare providers we always worked together to deliver this care together and so it's always been about not just me as a provider working with patients it's in front of me but also how can I work with this greater team of people and have a greater reach right me no bigger than yourself be able to do more and so one of the big things for us is we became employee owned in late 2015. And that employee ownership accountability piece for all of us as healthcare providers is a real big part of who we are. We really just think that we're a better team together and we work much better as a team and we think that benefit only patients that are there. So that's a big part of that employee owned piece because day to day on our team we've got people always and that's super exciting what we're doing on this great grandiose large scale here locally. Like I said we're still working with patients face to face and so that employee ownership together and working together has been really powerful and surprisingly is not real common healthcare. You don't see a lot of it. So you know that's a big part of it.

Saul Marquez: [00:07:20] That's great. Yeah and it's it seems like in fact it's going the other way with large systems purchasing practices and it seems like it's going the other way right now and you guys decided to give the ownership to the employees. I don't know. Did an Aesop over there how you executed it but I guess the bottom line is your employees own the company and they have the skin in the game.

James Glinn: [00:07:45] Exactly. They own not just the company but they own the care that they're delivering. And so you know if if if you're a patient thinks to delivered by God you want to be carried over by a publicly traded company. Really again there are some fantastic amazing publicly traded companies or do you want it delivered by the person right there in front of you right there that they don't care. So it's been really important for how we think you know as an organization and I think that's a big area where we can really differentiate and do some hopefully amazing thing.

Saul Marquez: [00:08:14] Hey that's cool you know and I appreciate your diving into that distinction. So as a provider we're a provider listener. It's not that hey you know what not only do you own your practice but you also own the care that you're delivering. And I think this is definitely a thought that could shift a practice or an organization. So kudos to you and your leadership for doing that kind of shaping.

James Glinn: [00:08:36] Well thank you. Yeah it's been really important to both me personally but as well to our whole team and our communities.

Saul Marquez: [00:08:42] So Jim maybe you could share with the listeners a time when you had a mistake or a setback and what you learned from that.

James Glinn: [00:08:49] Oh you know my biggest mistake particularly in healthcare and I think it's core and what we do is when I forget you know you start looking at data and when what's possible and it's easy to forget that it's all about people and so you know my biggest mistake when I forget that healthcare is a person people centered driven thing and you can really use yourself and really miss the value that you do when you start to depersonalize things and just make things data. At the end of the day what we're trying to do in healthcare is make people healthier. Help them help them be better. You know there's all sorts of ways to do that but it's 100 percent in my mind.

Saul Marquez: [00:09:28] I think that's great. And maybe you could take us to one moment in particular and let us know what you took out of that one particular time.

James Glinn: [00:09:37] There are so many particulars in terms of where it's easy to forget about people particular as we've been working on this software and this platform for delivering the clinical practice guidelines and people those things but the moment to remember that the value of people is when they're patients sitting right in front of you that person's in front of you they're in a vulnerable position. That vulnerability comes with responsibility on behalf of provider and so when that's forgotten you lose all the authenticity and all the magic of what's possible. And it's a quite unfortunate thing for the patient and so I hate to say it but every provider right now gets bogged down with these rules and regulations and I know not to go off on a tangent but very difficult I'm sure you heard from some of your other. Yes that's a very very difficult. Yeah you have to remind yourself that this is a people people thing we're doing this. Yes it was data and yes it's important and data can really guide and enhance our decisions. But still a person so that just becomes really the area where you just take yourself because pretty soon you realize you're checking boxes or the same as the federal government you know a private insurer whomever it may be that's not really here.

Saul Marquez: [00:10:52] Is there anything that you do to help stay centered any rituals any any symbols anything around your office that you have that help you remember when maybe you have a hard time.

James Glinn: [00:11:03] Yeah there are a number of things we believe in real simple consistent messages. So in our team we use what we call the three As and three As of really simple ability access and atmosphere ability and we deliver responsibility to be at the top of our profession of what we do access we feel people need to have access to the services that we provide. The larger the local nature a lot of it in an atmosphere you know you've got to do it and I think that fun healing environment. Otherwise what we do becomes very tedious and difficult. So we've got those symbols all over. I think we need to remind ourselves of those things all the time and when we do we seem to keep practicing balance and to deliver what I consider here at the top of practice.

Saul Marquez: [00:11:46] I think that's so cool. Thanks for sharing that. You know I always wonder what different people do to stay focused. And if I could pull a nice little gem out of it just like shared right now that's a success. So listeners think about ways that you could do like them Triple A. Access and the other two that he mentioned. Just think of your own ways of doing this because that's the way that you're sure to set up the systems to have success in delivering what you want to do most. So Jim what about your what are your most proud leadership moments in medicine today.

James Glinn: [00:12:19] All the most private moments of the shared experiences of our team and so you know the proudest moment was me because it was quite a tedious process to get there was when we finally became an employee owned health organization. That was something that we were long hard towards and as a mature is really important.

Saul Marquez: [00:12:36] Now that's huge. Man how about an exciting project that you're working on.

James Glinn: [00:12:40] Well you know earlier I mentioned and that's where we've been spending a whole bunch of time really trying to take some of this data and hopefully that we're also able to humanize that as much as possible and be able to deliver that. So we've got that are we are basically allows the individual accessing the platform the ability to sort of pick the mind of all the best research physical therapist and the clinical practice guidelines that they've published in The Journal and work in sports physical therapy and so really I hate to think it sounds simple but what we're really trying to do is just acknowledge useful and so it's been a really exciting process. We've got patients on the platform now and we've got data coming through there. I think we've got some great outcomes that are coming out of it now and so it's really exciting to see what's possible on a digital platform in what health processes are very human profession.

Saul Marquez: [00:13:35] Yeah. Jim so that's really interesting. So tell a moment that. Who would use it who would use the platform somebody who is Love therapy.

James Glinn: [00:13:44] Absolutely yes. So someone in an area where they don't have access to quality physical therapy or you know there are all sorts of small rural or rural areas that have great access to internet and data but there's not a whole lot of medical and allied health professions in those areas. So you know those patients are individuals that want to learn a little bit more about aches and pains who might be having that neck pain issues. Any of those things. It's a great place to go. And then on the provider side it's a great place to learn more about patterns and what sort of patterns present in the Musculoskeletal world. So it works for us high as training and education to providers because some of the patterns you don't have as you working on it and who doesn't want to know a little bit more about ache that they have in their back or their shoulder or whatever it might be. I think it's a pretty great resource. So listeners Jim and his team Andrew Cherry and the folks over at telemovement have put together an offer for you if you go to You can use the access code OUTCOMESROCKET4U. That's number four. You saw outcomes rocket number four letter you everything is in caps. You're going to get a free 30 day trial to the tele movement musculoskeletal platform because these guys care and they want to get you healthy back moving right, Jim?

James Glinn: [00:15:10] Absolutely yeah. And we would love any feedback. This is a learning process for all of us. This is the future of the delivery of some of the services that our professor provides. So we really want to make sure that we're thoughtful as we move forward so what we would love any feedback.

Saul Marquez: [00:15:23] Absolutely listeners, so there you go. They're giving you a 30 day trial. Go check it out if you get a pain somewhere. Check them out and be able to help you find the source of it and maybe some solutions to it. I think this is really great. And don't forget to give back feedback which is what they're looking for. So this is so interesting. Let's pretend you and I are building a medical leadership course and what it takes to be successful medicine. It's though 101 or the ABC of the Dr. James Glinn. I've got four questions for you. Lightning round style and then we'll finish up the syllabus with a book that you recommend to the listeners you ready. I'm ready. Awesome. What is the best way to improve health care outcomes.

James Glinn: [00:16:05] You have clear expectations and meaningful rewards.

Saul Marquez: [00:16:08] What is the biggest mistake or pitfall to avoid.

James Glinn: [00:16:11] Just like her. And don't forget that it's always about people.

Saul Marquez: [00:16:15] How do you stay relevant as an organization. Despite constant change.

James Glinn: [00:16:19] Just care you have to actually give during that to care about the people on your team.

Saul Marquez: [00:16:23] What is one area of focus that should drive everything else in your organization.

James Glinn: [00:16:28] So I mentioned those earlier. For those that's the three is ability access and atmosphere.

Saul Marquez: [00:16:33] Boom that's awesome. And so what book would you recommend to the listeners.

James Glinn: [00:16:38] The most recent book that people asked me a recommendation. I just really love thinking fast and slow by Daniel Kahneman that I thought there were just so many great lessons for healthcare providers in the book

Saul Marquez: [00:16:48] Thinking fast and thinking slow listeners these nuggets of wisdom all put together in this nice syllabus along with this book. You'll find the link to it. You'll find all of the the show notes that we've discussed today go to That's D R G L I N N and you'll be able to find everything that we discuss here today. Jim without further just the anticipation I just wanted to ask for you to share a closing thought with the listeners and the best place where they could get a hold of you.

James Glinn: [00:17:24] For the listeners. I think here are what I want is a closing thought people keep in mind this is how important the ability for all of us to work together step out of some silos that we get stuck in As healthcare providers in and anywhere in the healthcare system that you may be working on or otherwise because look we all want to be healthy whether we work in this system or not. And so you know I think more we can do to collaborate together I think there's still all sorts of opportunity and the possibilities are endless love to talk talking more listeners. I'm Sparksman more time than I should on Twitter. I'm @jglinn and would love to have anyone reach out there and some conversations accordingly.

Saul Marquez: [00:18:04] Love the invitation listeners take advantage of that invitation. Reach out to Jim via Twitter. And don't forget about the promo we'll include that in the show notes as well. But just as a reminder its and you can have a 30 day free trial if you go to OUTCOMESROCKET4U all caps so go to the show notes get that information and check them out again. Jim really want to say thank you for joining us today. It's been a ton of fun and rural looking forward to seeing this program. You guys started just flourish to success.

James Glinn: [00:18:39] Hey I sure appreciate now and thank you for offering this platform for people to have these discussions and I think they're important it's definitely appreciated. Thank you.

: [00:18:50] Thanks for listening to the outcomes rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Thinking, Fast and Slow

The Best Way To Contact Dr. James:


Mentioned Link/s:



Episode Sponsors:

Healthcare Podcast

Outcomes Rocket Podcast - James Glinn

Outcomes Rocket - Keith Grimes

Virtual Reality and its Exponential Advances in Healthcare with Keith Grimes, Founder of VR Doctors

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Outcomes rocket listeners, welcome back once again to the outcomes rocket where we chat with today's most successful and inspiring healthcare leaders. Hey I really want to thank you for tuning in again and I am by to go to where you could leave a rating and a review for our show today or if you just want to share what you think about the show in general. We love hearing from our listeners. Without further ado I want to introduce an outstanding guest. His name is Dr. Keith Grimes. Dr. Keith Grimes is a geek a gamer a general practitioner who has spent over 25 years integrating technology and medicine. He has a passion for digital health and works tirelessly to innovate at the front lines as a founder of E.R. doctor. He's currently exploring the role of virtual and augmented reality in healthcare. He's got a lot of really cool stuff under his belt. And what I want to do is open up the mic to Keith to give us a little bit more of intro in that bio and just welcome you to the show.

Keith Grimes: [00:01:22] Yeah thank you. Thanks. Thanks for having me on. Yes I would like to add that intro. Well I'm 40 I'm a joint I'm 6 foot 6 so. So yeah I'm looking for. Head of the rollout of technology comes around. First post to clarify to American listeners Oman UK based business a GP or general practitioner is what you might call from. So more family physician. And then my personal trust within medicine is urgent and unchangeable. And then the rest of my time I'm a digital health consultant so I've spoken internationally on innovation health especially virtual reality but by corporations and small startups to help them think creatively about how they might solve problems and most recently on the founder of Beyond doctors which is a community of patients clinicians developers and academics we discussed connecting share best practice and clinical immersive media.

Saul Marquez: [00:02:15] That's so interesting and it's something that is surfacing a lot now at the development of that technology. Keith what do you think one of the biggest promises of VR in healthcare is.

Keith Grimes: [00:02:27] I think when you break it virtual reality offers everything. It's a computer simulation that offer either real or simulated world. You can interact with it and if you spend any time thinking about it basically allows you to do or see anything that you want and so the possibilities are technically endless. But if you look focused about what's happening right now I think that the interesting thing is that virtual reality has been has been around for a little while. The early 90s and already has some good use cases in areas such as hygiene control and mental health. OK she's an education training so it's already being used on small scale. And what's really exciting about virtual reality is that the current crop of consumer units particularly things like samsung view VR or Google daydream that you might use when your cell phones allows people to get access very very easily. And so the potential market for people using this I seek help has expanded exponentially.

Saul Marquez: [00:03:28] Yeah that's interesting. I really think that it's a fascinating place to play and you guys are definitely neck deep into it. KEITH Before you spark even lit. What is it that got you into health care.

Keith Grimes: [00:03:40] Well what got me into healthcare was my parents but not in the way that you might think because I come from a family of engineers and scientists. And my dad introduced me to computers back in 1983 gave me a commoner 64. I was 10 at that point and we were living in Singapore because I was a new oil industry. And I remember cyclings the local science museum to buy a book on programming that BMX might know how to code. And from then on I was hooked.

Saul Marquez: [00:04:05] That is awesome.

Keith Grimes: [00:04:06] So all the way through I was like yeah this is what computer games I'm going to go to university and studied computer science but I was doing too well occurrence put into that and said look you can be a doctor or a lawyer. And I thought well you must be a lawyer right. So so I became a doctor but actually through the MBA studying medicine and learning learning science and the art and craft of medicine. Now you know I love that my vocation is to mix those two loves technology and the medicine.

Saul Marquez: [00:04:36] That's so cool and a really wonderful story I just had this vision of you racing through the streets on your BMX to get that programming book and the cool thing now Keith is that night as we talk you know I still sense that inner child you think is absent in a lot of people that have been in the game for a while. And so I think that's pretty cool it's something that listeners think about how you can awaken that because when you awaken that inner child that's when you start thinking creatively.

Keith Grimes: [00:05:06] I couldn't agree more. Maybe finding those things that drove you when you were a child or a teen staying childlike and curious is the thing that's keeping me keeping me right keeping me on the right no burn outs you know because medicine can be a tough gig.

Saul Marquez: [00:05:22] Yeah for sure and I definitely get that from you. You know the times that we've talked Keith I mean just when we hang up I'm just like excited about medicine. You know and I'm just feeling hopeful again. So it's definitely contagious. Good good. Hey so tell me what do you think Keith should be on top of mind for medical leaders right now.

Keith Grimes: [00:05:42] Ok so all medical leaders have to ask the question how do we integrate the exponential advances in digital health into what we're doing. And so this will help I'm talking about the revolutions and aspirations and genomics virtual artificial virtual and augmented reality digital drugs tele medicine. All of those things because they are steaming ahead in society as a whole and delivering benefits to people in lots of different sectors and healthcare should be no different. But healthcare is a little bit conservative a little bit more slow to move. And so I think the medical leaders need to be gaining an understanding of this maybe getting some practical experience from the robotics sector.

Saul Marquez: [00:06:25] Keith That's such a great call out right. I mean you've got so much technology that's available but yet very little of it is being implemented. What advice would you give to healthcare leaders and practitioners or administrators and even med device companies and making this more use friendly user friendly.

Keith Grimes: [00:06:43] Well if I were speaking to those particular audience I'd say you won't make it user friendly. You got to think first about your users and ultimately in healthcare you're talking about the patients. Yeah the patient make the patient your focus.

Saul Marquez: [00:06:56] That's such a great call out. And I think you in particular do a fantastic job about about that maybe you can dive into some examples about how you've helped improve outcomes through keeping a patient in the center.

Keith Grimes: [00:07:10] Yeah well I mean these are all good. I mean there's been a few different examples where I've been trying different technologies but the one where I'm actually where the two came together was with virtual reality last year and again it came from listening to patients. Now I'll talk a little bit later on about the dangers of leading with the solutions as opposed to the answer of the problems. But in this case my interest in virtual reality is years old. I go homeless in the UK and I was playing with it playing games looking and thinking about how I might be able to use but one of my patients while I was doing all this. One of my patients came in and he was a big tough guy played rugby. He retired you know and we often have a laugh talking about the scrapes. Yeah. And so you know player Tough Guy Yeah yeah. Was an international Scotland actually. So we all knew what we're talking about when it comes to scrapes you get involved and what this poor guy had a leg ulcer. And he would tell me that he was in tears when he was having his dressing done now for those of your listeners are to be medically useful trying to understand the stresses changes when you have a wound to help optimize the healing and change dressing can be quite painful and it's easy to make out training experience because you can't sedate everyone particularly in primary care and giving the oral medication often often doesn't do the trick either. So you spend a lot on trying to distract them so after that discussion with a patient I just have a light bulb moment. I was like well he's got this problem. And actually I knew about virtual reality and there's a good evidence base how it can help reduce crime. Principally it was dressing changes and I thought well why the hell not. And in fact that's the lesson is that you are so special about this quite often you just have to do it. You just have to get up and do it. I had my first opportunity with a pregnant lady who had just given birth she's been drastic changes and she was really scared of having it every day and she's breastfeeding it's difficult to get her medication. And so I just said well you know I've got this hardware I've got this solution we can try virtual reality what do you think and she said yeah why not. And I was off we used it it was stunning the difference it made for her. She was really scared beforehand but she was happy she was laughing while we were doing the dressing you know we have to remind you we finished. And so I was but impressed upon me was the power of this consumer technology for this particular patient to reduce our. And that set me on the task of trying to convince my patients. So I'm working with my patients and offering what I can to help them with dressing changes all of other folks just like Lukla taking samples blood Joines injections and so on. And I think at least from my own personal practice that's with some really lovely outcomes.

Saul Marquez: [00:09:47] And I think that's really interesting. And it sounds like it's one of those things that's readily available so if you're a provider that's you know I encourage you to get inspired by Keith then think about how you could think outside the box the healthcare box and outside of the box there's something technologies and sounds like this made a big difference for her and several other patients.

Keith Grimes: [00:10:10] Yeah absolutely. And it's led me to on this path of sharing my learning and that for me with Villoldo as I was going to say the you know those close people out there are interested in doing this but are scared about just using off the shelf solutions as definitely to provide as other at least in the states that have a ready medical grade solution you've got Howard Rosen first hand technology with cool and glow connected our cable headset version that's got really good evidence for acute and chronic pain. And then you've got the work of applied the law which has been used so successfully by Brennan Siegel at Cedar Sinai which is Samsung Geary or so. So those people are interested in giving it a go you might want to lock them up because they tried the whole package service.

Saul Marquez: [00:10:52] That's awesome. Thanks for the resources Keith and listeners. Make sure you note that. But we'll also included in the show noted. So you could come back to the show are online and click through if it's something that you're interested in pursuing. Keith can you walk us through a time when you made a mistake or fail and to take from that.

Keith Grimes: [00:11:09] It's what you were asking is a really really important thing for people involved in innovation and leadership to talk about some very happy too. There's no shame in these things you learn more from your famously different sets don't you.

Saul Marquez: [00:11:21] Absolutely.

Keith Grimes: [00:11:22] Yeah. And for me personally it was my time as a Google Glass Explorer. So I'm sure everyone remembers Google Glass the day when it was on Google was pitching it to consumers. And I got caught up in all the hype and I became an explorer I it. It was quite expensive. It was just over a thousand pounds so most of the dollars here and I but I learned a lot from just trying the technology so I got to my practice I started my medical indemnity to make sure I was OK. I don't think about how we could safely use and then start using it in my practice. Now you know some things worked well unfelt looks really cool. It was actually really helpful to taking pictures and videos strictly documents to correct procedures when my hands were well occupied. And I really loved the way the notifications works. Let me actually develop something called Gwyther which is not a word but it's where the connection with the Welsh was to be formed because we developed it. Why else was the name essentially Gwyther. G W why B. It was a half day when we experimented with it it was great and it was interesting but basically having such a small screen that was intimately connected to the Internet to one side. When I had a massive screen next to me with a tablet connected to the internet didn't really add enough. And then as time went on little things started copper popping up for example I forgot I was wearing. Now that was a major issue but on one occasion I was doing Strictly Personal exam on a female patient and then I came away and we're talking about so what's on the side of your head. And I say I guess that's a camera. But don't worry it wasn't a priority. You know those things are best practices now. Yes. And then what stopped me using it at that time was when my patient suckers turned with schizophrenia. Assortative was talking about. And he said to me I know what you're wearing but why are you wearing this. And I couldn't answer it properly. I thought my time using Google Glass is there. And so it was an expensive experiment I learned something from it but ultimately it didn't work out there.

Saul Marquez: [00:13:22] Yeah. Now thanks for sharing that and you took a couple of bumps here and there you experience some good uses out of it and then decided not right now you shelved it right. I mean it's not like you've given up on it you just shelved it.

Keith Grimes: [00:13:35] No no absolutely in fact you know Google Glass has been has actually got itself working very nicely in enterprise solutions. I think that was the main thing is that you know as a consumer offering it wasn't there but enterprise in fact I've been involved in a project called See what I see in my locality where we're looking at using Google Glass as a way that doctors who do remote visiting patients in care homes and you know that there's a lot to just that might be very useful all providing expert support to paramedics in the community through a company called expertize. And again I can send you the details of the Show notes.

Saul Marquez: [00:14:08] Perfect. That would be really great for those listeners that want to tune into that. It's a very interesting space that Keith is working on. What would you say Keith is one of your most proud medical leadership moments that you had to date.

Keith Grimes: [00:14:23] There's been a few that I've really enjoyed being involved in. The one I'm most proud of was a project called My little one and my little one was a project that was undertaken by the company I worked for as an employed doctor. It's great to care 24 under additional health care Institute in Scotland and very simply put respect to not short notice to provide a solution in a Neonatal intensive care units in the intensive care unit what sometimes happens is that the children are very unwell and the mother is very unwell and as a result the composites. And so we were able to use off the shelf hardware for cameras and an iPod to allow parents to visit their children in intensive care. And it was something that we did in conjunction with the Royal Victoria Hospital in Kirkcaldy and was also evaluated by the Glasgow Caledonian University. So for groups people coming together really quickly and delivering what was a really amazing solution. Just using hardware that we had available and each of those sites and the thing that really made me proud is that we must turn that around quite quickly. Zákon running I remember we launched on the 7th of no member 2000 and 15 at that time. I remember we gave the hardware that the tablets the the mother who sits next the baby and explained what was going on and how she should try to take it back from us again that's no problem. Lizzie went upstairs and I realized shortly afterwards I had to get her back to do something tech folks. And I went upstairs and came into her room and in her room she was sitting at the top of her bed with her partner and they were sitting very quietly looking at the end of their bed where they are propped up the tablet just watching TV. And at that point I thought Yes yes this is this is what it's about. This is a living benefit right.

Saul Marquez: [00:16:07] That's awesome. That's a great story. I amateur. I mean how did you feel when you saw that.

Keith Grimes: [00:16:13] It was really touching to see that it was really touching to help. I mean I knew intuitively that working in this space would be really really helpful but to actually see it happening was something else and I'm really fortunate as the doctor we get to see moments but happy moments and sad moments away. Maybe more you're seeing this thing also maybe Prouse is seeing how motivated the team I worked with were on delivering something that had a direct impact and that's the lure of working in digital health because you're doing something that's really good. And I've seen that motivate people very well so it's lovely.

Saul Marquez: [00:16:50] That's really great and I just am inspired by the story and it's great to enable this type of care and health care through technology. Keith and you guys are doing a really great job. So tell me about something exciting that you're focused on today.

Keith Grimes: [00:17:06] Well one of the things I'm focused on right now I'm really excited about it as is or is virtual reality obviously I'm virtual and augmented reality. So last year I founded a group called B-R doctors which your listeners can you are very welcome to join us on Facebook at the moment. It's a physical release. Remember we discussed and share what we're doing and three that's very proud of that and there are two things that come out of it and particularly excited about the first of which is a collaboration on working with a hospital in London the royal Brompton half of this came be just is the benefits of sharing things. So I was talking about why I was managing with the OB with my patients the practice and the consultant Mr. Simmental Boudia who is a cardiothoracic surgeon working at the Royal bronzing healthcare got in touch. He said look I had this idea you know I'm where I work. We have patients going to intensive care and when they go to intensive care some of them have traditional skills post-operative delirium where they're confused or agitated and that's up to about 80 per cent of people that have major surgery going into intensive care. Now those people need to stay in ICU for longer. Those people end up sometimes longer more complications and it's difficult to manage that he said. But we know that if we take people before they to be taken in there and show them around make them less anxious and that reduced anxiety can reduce post-operative delirium. And he was saying well we don't do this and so I picked up McGeer and went from met with him when we marked something up you know using a 360 camera under a mask turned into a project called prevents ICU delirium which has a psycho psychological resilience through the exposure through the use of virtual reality as a mobile therapy in an ICU delirium. Some we're working with with medical realities you met some of them over Shuf Ahmed is a company that he works with. He's involved in America must make a platform which takes a randomised controlled trial next year. So I'm tremendously excited about that and my involvement and that's an advisor and then more personally I've been exploring the area that that family practice of primary care physicians it's it's our domain it's it's not our place. Consultation is where we meet patients. That's where all the good work happens. And so I'm exploring what it might be who salt patients inside virtual reality and posting that on Twitter on Keith Grimes and on all my websites which I'll get to details Neander. I think that is a serious social clubs and just basically trying out and exploring and sharing and you know like because I think that going forward. Virtual reality might be a platform that people will want to discuss in augmented reality too. You might want to meet your doctor and I think there are some real real benefits of doing VR so I'm just exploring just now and that is exciting.

Saul Marquez: [00:19:45] It really is Keith. You're always on to something new something awesome but what I love about the way you do it is that you're always doing it with the patient at the center and it's just very very inspiring. You could try gadgets just for gadgets sake. Are you good. Dr Grimes does and keep the patient in focus when you're doing.

Keith Grimes: [00:20:06] Absolutely. That's really important.

Saul Marquez: [00:20:07] So Keith let's pretend you and I are building a medical leadership course and what it takes to be successful in medicine. That's 101 are the ABC of Dr Keith Grimes we're going to write a syllabus together. I've got four questions for you. Lightning round style followed by a book that you recommend to the listeners. You ready yeah.

Keith Grimes: [00:20:27] Ready to go.

Saul Marquez: [00:20:28] Awesome. What's the best way to improve healthcare outcomes.

Keith Grimes: [00:20:32] Listen to the patients.

Saul Marquez: [00:20:33] What is the biggest mistake or pitfall to avoid.

Keith Grimes: [00:20:36] Don't lead with the solution.

Saul Marquez: [00:20:38] How do you stay relevant as an organization. Despite constant change you have to be nimble.

Keith Grimes: [00:20:43] Use existing technology learn from the best implement and learn fast and then share what you know.

Saul Marquez: [00:20:49] What is one area of focus that should drive all else in your organization or practice.

Keith Grimes: [00:20:54] For me as a doctor it's about making the care of my patient. My first concern I always say from patients that they are the captain of the ship I'm on the first officer so I advise I implement their orders and I help keep the ship safe from that and possibly that. So my role is to just.

Saul Marquez: [00:21:11] Love it and Keith what book would you add to the syllabus for our listeners to read.

Keith Grimes: [00:21:15] Can I mention two.

Saul Marquez: [00:21:17] Please.

Keith Grimes: [00:21:18] Briefly my first book is watching the graphic novel by Alan Moore David Gibbons and John I'm bringing this up because I said I'm a geek. And reading that book when I was a teen was my eureka moment when I understood the power of comic books to address adults and global themes. But when it comes down to health leadership and medicine it reminds me about the complexity of the world about how being a leader isn't simply about trying to be Superman. We have to be accountable or as they say in the book who watches the. And in terms of the leadership tax one of the great books I read recently was in search of the perfect health system or my Matt Brittnel. It's really good. It's got lots of short chapters. The travel is the world looks all different health care systems and just to work out what works and what doesn't work. And it reminds me that the best solutions to our problems are most often found out are areas.

Saul Marquez: [00:22:10] I love that. I always wondered that Keith. I wish there was a way that I could learn a little bit more about all the health systems in one shot. And it sounds like this is the book.

Keith Grimes: [00:22:20] Oh yes. Really good and like I said lots of short chapters so you can put it down and then he makes use of them. He makes and comments and thoughts at the end. The NHS is awesome. It pops up for being brilliant for the equity of access to other things. So Saul says what would be the ideal system and sort of mixes matches and this is really interesting.

Saul Marquez: [00:22:40] Just wow so cool. Thanks for that listeners. This is the cool thing about the syllabus portion of the show is that these amazing leaders in healthcare come at their best. They distill it in these little nuggets of wisdom and then these resources the books like Keith just mentioned. Don't worry about writing any of it down. Just go to that's D R KEITH and you're going to find all of the show notes as well as the syllabus and the book as well as any links that Dr. Keith Grimes wants to share with us. Keith what would you say a closing thought is and the best place that the listeners could get in touch with you.

Keith Grimes: [00:23:22] I think my closing I mean I've a little bit about the importance to focus on patients. But one of my closing thoughts. I'd like everyone to just do it. Just sometimes you have to be bold sometimes you have to be brave sometimes you have to take risks. And it's absolutely right that you are careful and you minimize any particular risks that might come out of this. Ultimately you have to take that step. Ultimately you have to do this and if you're involved in innovation sometimes you have to be the first person to do this and you're going to have to take that step. So my closing thought is that you got the idea that you've got something that you think will help and you want to take it forward. Just do it.

Saul Marquez: [00:24:05] Love it. What a great message and what is the best place that the listeners can get in touch with you or follow you.

Keith Grimes: [00:24:10] Yeah well Twitter is a really good way of contacting me or just following when I go to a site I post pretty extensively. So @keithgrimes. Yes my Web site which is that you type a kind of put everything back so I have a podcast. It's the account where I get additional health VR as we're all accessible. And if you want to get involved and be like I said my friendly bunch Facebook search vr doctors where you go.

Saul Marquez: [00:24:46] Fantastic. Really appreciate the time you spent with us today and I'm really excited to see where you and your fellow peers take VR and medicine. So just want to say thank you so much for spending time with us today.

Keith Grimes: [00:24:59] Thank you very much for having me. It's been brilliant speaking to.

: [00:25:05] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:


The Best Way To Contact Keith:
Linkedin - Keith Grimes
Mentioned Link/s:

Outcomes Rocket - Keith Grimes


Patient Outcomes

How a Standardized Health Score Will Improve Outcomes with Shakil Haroon, CEO & Founder at MPIRICA Health Analytics Inc.

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Outcomes rocket listeners welcome back once again to the outcomes rocket where we chat with today's most successful and inspiring healthcare leaders. I've got to say thank you so much for the support. We've seen our listenership grow tremendously and I feel like what we're doing here is resonating so do me a favor I invite you to go to Give us a rating and review let us know what you think what you want to hear and it makes our day whenever we hear from you all. So I invite you just go to Let us know what you think. I have an amazing guest for you today. His name is Shakil Haroon. He is the CEO and founder of MPIRICA Health Analytics they try to combine consumer friendly measures of medical quality attainment with cost information to help consumers and employers pinpoint the highest value provider in any location. It's a pretty cool thing that they're doing over there and the experience that Shakil has and his team I mean this guy's been across the entire SAS experience from his experience as a leader at Microsoft through his experience in sales at Spring wireless Axelle technologies he's got an amazing platform upon which to build an amazing platform for you the listeners and also patients and health care so I want to open up the microphone to Shakil, just say thank you for being on and then fill in any of the gaps that I missed in your intro. Welcome to the podcast.

Shakil Haroon: [00:01:54] Well thank you for the opportunity Saul. Really glad to be here and as I mentioned I think your focus on outcomes is important. And you know that is our goal as a venture to shed more light in what are the true outcomes in U.S. healthcare. Thank you also for that kind introduction. I sometimes think that my various experiences here paint me as a serial entrepreneur and and maybe in some ways that's that is the case. I've come to healthcare and find a lot here to apply my background particularly the analytics side of things which I find incredibly fascinating there's a treasure trove of information here for a data geek to get immersed in. So I appreciate being able to talk to you today about all this and my experiences thus far.

Saul Marquez: [00:02:39] Absolutely Shakil and definitely serial entrepreneur is would scream at me too from what your experience and of what you've done what is it that out of all the things that you have done that made you gravitate toward the medical sector what got you in.

Shakil Haroon: [00:02:54] Well I got into this particular venture a few months after the acquisition of a company that I was part of the founding team. So back in January 2014 Excellus technologies which was in the software security space was acquired and left me with a lot of time on my hands and maybe the luxury of being able to spend a few months thinking about what's next. Like most entrepreneurs you tend toward trying to solve a problem that you've encountered personally and I suppose that was true in this case for sure. I grew up overseas and one of the aspects of my upbringing was having family members get on planes trains and go and get healthcare abroad. That was something that I experienced growing up it was a big rigmarole an entourage would leave and return a couple of months later and you know in my own immediate family we had the situation. One of the most important questions is you know how do you pick a provider that you're going to travel across the globe to go see. And like most healthcare consumers their choice was made largely on hearsay such and such. Hospital is renowned and such and such. Doctor is a miracle worker. And that's the basis how people in those care settings. So I wanted to address a problem that I've kind of grown up with and delve into. Well how do you know that these are the best places for you to go to especially these are your loved ones and you want to see them come back home. Well you know that once you traveled all this way let the place you've ended up is in is truly the best place for you. So I decided to go in and try and tackle that problem applying some background in technology maybe a more analytical approach to problem solving. My background is I'm a little engineer by education and so tend to gravitate towards numbers and analytical approach as opposed to kind of. Taking at face value. You know whatever claims a hospital or a physician has. So I wanted to go in and take a look at the numbers and the actual data to back up these claims of excellence and to be able to advise people coming to the United States from foreign countries some 500 600000 people do that every year and provide them a resource where they can match up with the best providers given their particular condition. And then the business quickly evolved from that point when I discovered that well not only people overseas have no idea as to who the true best performers are but you can be in the same city across town and not really know who the best provider might be for your imper placement your knee replacement your heart surgery. It's all very much hearsay reputation driven business record actual data supporting these claims to being Mercal workers is a well-kept secret. Let's put that that's. I want to I wanted to crack that problem. And that was the really the genesis of Karega.

Saul Marquez: [00:06:01] Now that's a really great call out. It's definitely an opaque process. As a patient you want to get care. It's not the easiest to really understand and aside from hearsay are really awesome marketing billboards or buses. It's just hard to really understand hey you know what are the metrics behind this claim and what you're doing is awesome. You know you're taking the bull by the horns and you're saying wait a minute this is possible we actually can. And so I'm excited to hear a little bit more about how you guys have tackled the challenges and maybe some success stories you've had to date but super exciting and kudos to you and your team for putting this grand vision together and start nipping away at it.

Shakil Haroon: [00:06:45] Well thank you. Yeah well it's a new area that's fraught with mystery and to a great extent that mystery is highly profitable for the practitioners. It's also complex. I'm not not to say that this is entirely the product of wanting to keep the performance hidden but it is a complex area. You know how do you measure the quality of a particular facility or are an individual physician when you've got such a huge variance in the conditions of the patient the socio economic realities of the patient. So these are complex subject matters to deal with. So we we had a very rich environment to go in and seek out in trying to solve this. But I think what we have today is the start of some very reliable metrics that are starting to improve our even end goal tests that we were onto something. And so we're eager to share this with consumers and payers particularly employers out there.

Saul Marquez: [00:07:44] Shakil and it's really really great as your platform available for consumers today or are you guys still in the working and out stage.

Shakil Haroon: [00:07:53] No it is it is certainly available at where we offer up some 44 or 45 different procedure categories to consumers for them to check out. So for anyone to host the 5000 hospitals around the country consumers can go in and for free check out the performance of the facility in their area. So if you've got high risk high cost procedures that you or a loved one are contemplating we offer a free service that you can go and check out who might offer the best care in your area. And sometimes the results that you'll see might be a surprise. But again we're trying to do is to focus on true outcomes and less on the marketing that goes into this field. There's hundreds of millions of dollars here at stake at any given facility for the procedures that they perform. And so there is an intense desire to stand out and be recognized as the best of the best. What you'll find is that when you're taking a look at the actual data or the actual outcomes from episodes of care that were done sometimes the reputation winds up and many times it does not. So we're we're here to pop the bubble of you know marketing and introduce the actual reality of outcomes to the benefit of consumers in scale.

Saul Marquez: [00:09:17] So cool. And so I want to take this a little bit deeper let's dive into it right. You and your team have put together what's called the Empiric quality score which is basically what everything that a consumer would go in and choose a provider with is based off this score. Can you kind of walk us through what that score is put together from the bits and pieces so that the listeners have a better understanding of it.

Shakil Haroon: [00:09:41] Sure. Try to provide a high level explanation here of what what goes into production of being Perko or Costco or as I mentioned earlier this is a very complex undertaking. It's not as simple as totaling up the number of deaths that occur at a facility or the number of complications that occur and that at the end of that you've got a spreadsheet that tells you who's the best and who's the worst that is actually a very misleading way to do it because it does not take into account the patient risk factors. What is the health of the patient walking in the door. Because if you've got patient with diabetes with heart problems that might be old and sick. The outcomes that you're likely to get even though you might be an excellent surgeon are very likely going to be inferior to an otherwise healthy individual walking in the door for care. So this issue of risk adjustment or factoring in the patient condition is critical to getting an accurate measure of hospital or physician performance. And we do that we consider some 500 risk factors that are about assessing how risky the patient is to treat and how likely it is that a given course of care is going to be successful. So after this risk assessment we then predict the expected performance of a hospital or physician across key outcomes measures such as severe complications the likelihood of mortality in patients the likelihood that a patient will complete the procedure but then have to come back in for a do over or what's called a readmission. So these are key outcomes measures and what's important about these outcomes measures is that they are not really subjective in nature. They are binary and so when they occur there really isn't much interpretation that needs to go on a readmit as a readmit. Obviously mortality is quite clear and similarly severe complications can be tracked. We then compare these predicted values with actual values. So we take a look at claims data for example and say well did the predicted readmit actually occur. And from that comparison between the predicted and the observed were able to determine how well a facility or a physician is doing if they're doing better than predicted for a given risk profile of patients. That is obviously a mark of a good surgeon or a good facility. But we don't just stop there. We have to see a consistent pattern. So over hundreds of episodes of care and in the case of a surgeon over four years of data that surgeon has to consistently do better than predicted in order to earn a high empiric score. So things can go wrong and surgery is risky sometimes for unforeseen reasons. Those outliers don't count in our situation unless there is a pattern that's observed again over several hundreds of episodes of care and over a multi-year period. So what we end up with is a very accurate measure of a facility or or surgeon performance over a multi-year period and where the predicted values or be the observed values are doing better than predicted. We award points natto in that approach an empirical score of 600 and above indicates a facility or a surgeon with an excellent track record of care. These are the surgeons that are able to take high risk patients and consistently produce great outcomes. These are the surgeons who have the fewest avoidable problems remember problems will occur in surgery settings. It's by its nature a high risk effort but it is those facilities and those surgeons that are able to produce the fewest problems despite a high risk patient environment. Those are the guys we want to celebrate. Those are the guys that we want to bring to the attention of consumers and payers ultimately for you or your loved ones. Those are the providers that you want to go out there.

Saul Marquez: [00:14:06] That's pretty cool. And it's like. And I'm just thinking through this and looking at the lay out of your of your tool here. Shakil, you know it's a lender will not lend you money if you have a bad credit score. So why would you lend your body to a provider with a bad empirical score.

Shakil Haroon: [00:14:25] Well that's that's a great way of putting it. And it does point to the issue of trying to avoid risks wherever you can. Absolutely. Is an innately risky undertaking and I think you know hospital executives will be will readily acknowledge that. But can you minimize that risk can you avoid taking unnecessary risks. That is what we're up to to help you do and the risks are real. The difference between the best performing surgeons and the ones that are poorest performing in any surgical category is a four to five hundred percent sometimes more delta. So that difference is significant. You would not get behind the wheel of a car that had a 500 percent safety difference between the best and the worst. So similar reasons you wouldn't want to be treated by somebody that has a four or five hundred percent worst track record than a better practitioner or especially because more often than not and almost without exception every city has both levels of performance so you can very easily direct yourself and loved ones to the better end of the performance range rather than subject yourself to the risk at the lower end.

Saul Marquez: [00:15:42] And that's a really great point. And I like how this is coming together and listeners if you haven't taken a look at this it's worth just visiting and checking out the layout here. Go to and you'll see what we're talking about here the layout the scores. The risk is red for below average outcomes. There's yellow for fair outcomes there's green for excellent outcomes. And at the very least go get a feel for what things could be in health care today as it relates to outcomes. As a consumer if you're an employer think about the value that you're getting for your health care for your employees and is does it measure up to what you're paying for. These are the things that we've got to be thinking about as people that are consumers of health care. And I think what Shakil and his team put together is exemplary. Shakil, tell us a time when you made a mistake or failed. Take us to that moment. And what did you learn to make MPIRICA much better or just your approach in healthcare. Excellent.

Shakil Haroon: [00:16:52] Thanks for the question and kind of puts me on the spot as a startup company. Mistakes are kind of what we have for breakfast. So sometimes it's hard to pick out one that really stands out but I would offer up an example of our getting excited about this idea of sharing cost savings that would accrue from picking the best value provider with the employee and in particular what I think we did not choose well or decide well was to invest in the platform technology that would make these these cost savings offers directly to the employees. Sometimes being too early with an idea is has the same net effect as being wrong. And so I think in that regard we were certainly too early in that regard. It was a mistake. However we are following the same approach configured with benefits consultants and that is proving out to be more in line with where the industry wants to go as opposed to making a platform and software means of delivering that financial benefit to the consumer. So that would be perhaps one thing that I would do differently if I roll back the hands of time. It's really a benefits consultant driven program as opposed to a software platform program. So I think I think the choice of how we delivered that capability was in hindsight way too early. We're sort of putting that code on the shelf until the market matures a lot more and when it does we'll roll it out again. But it's clear that right now the software capability is very early and it's better delivered by other channels.

Saul Marquez: [00:18:39] That's a really great learning, Shakil and the fact that you kind of able to assess the situation and identify that hey the benefits consultant this is where we got to we got to aim our efforts at and that you've done it and now you've had some success with the benefit consultants. So you found your sweet spot but that code isn't garbage you're just putting it on the shelf for future use. I think it's smart.

Shakil Haroon: [00:19:01] Well hopefully the market will catch up. We think it will the consumer is still the ultimate person affected by what we do financially as well as in health. So having this information available in a saw software platform is something that directionally I believe will happen just have to the crystal ball gets a little cloudy as to when Ma.

Saul Marquez: [00:19:25] Totally get it. I totally get it. Sure kill give us an example of one of the most proud moments that you've had in this health care sphere to date.

Shakil Haroon: [00:19:36] I think that for us as an early stage company gets us excited and feeling that we're accomplishing our mission is having the information out there certainly to the benefit of consumers and to payers health plans etc. But there is another audience that we also pay attention to and that is health care legislators regulators that are responsible for monitoring the situation at large. So I would have to say that one of the things that I'm most proud of is being an information resource to our own state of Washington legislators and in particular our State Senator Karen Kaiser is somebody that had reached out to earlier this year to provide information as to the state facilities and the variance in quality that we're seeing across two dozen procedures that we cover. So just providing this information I thought was a high point of this last year and we've also done similar outreach to our state congresswoman who is in Washington voting on various initiatives around cost and quality transparency and making that available to consumers nationally both at the state level as well as nationally I feel particularly proud of you know on an early stage company delivering information of this sort is so critical to literally millions of patients both in state here in our homes in Washington as well as nationally.

Saul Marquez: [00:21:09] Now that's really exciting and I didn't even think about that information Netsch that you're creating here and pretty cool for our people running the country at the local level on a national level to having a resource such as yours so hey an invitation to the policymakers to check out the information on this website as well because get to make informed decisions if you're going to make good decisions. Shakil, let's pretend you and I are building a medical leadership course and what it takes to be successful today. It's a 101 course are the ABC of Sharqiya. And so what I'm gonna do is give you four lightning round questions will give me some prompt responses and then we'll finish up the syllabus with a book. Now you recommend to the listeners ready? Awesome. What's the best way to improve health care outcomes.

Shakil Haroon: [00:21:58] I think adopting an independent scoring approach that you can spread internally at first if you're more comfortable doing that and having everybody be aware of where you stand relative to your peers nationally for the procedure categories you're working. So not all are possible score that nobody is particularly accountable for but score that each and every department can post up on their walls and say hey here's how we're doing against our national peers. And look at us we are number three in the country or we're number 75 in the country. And what do we need to get to a better position. So I think you can't manage what you can't measure. You can't improve where there are no metrics. So adopting an independent unbiased metric that is actually objective is probably one of the most important things that can be done and that's proven by the way to be effective. I think that's probably the best way to improve healthcare outcomes let people know how they're doing and manage them to it.

Saul Marquez: [00:23:02] I love it. What's the biggest mistake or a pitfall to avoid.

Shakil Haroon: [00:23:05] Believing in your own press. Well you know there are huge dollars here at stake. There's thousands of employees livelihood at stake. It's natural for large organizations to want to put their best foot forward to the consuming public and in this case hospitals want to be known as uniformly excellent throughout all of their service lines and all of the doctors on staff and nurses on staff are just miracle workers. I mean that is very much the marketing message they want to promote. I think believing in your own press in this case can be dangerous because what it does is is limit true improvement from happening and especially where you have hospitals that are similarly situated in terms of patient risk. You now get to be able to measure against their performance and say hey how are we doing with the same risk of patients or the same challenges if you will. So getting overly invested in your own marketing message leaving in your own press I think is a danger. It's a mistake. It's a pitfall.

Saul Marquez: [00:24:14] How do you stay relevant as an organization. Despite constant change.

Shakil Haroon: [00:24:18] As a high tech entrepreneur we've been the beneficiary of taking advantage of change and good companies and achieve success of personally as well as in business because we were good at taking advantage of change. So I think that it starts with a philosophy of not accepting change as just inevitable but but actually capitalizing on the opportunities that change brings. So investing in things like innovations teams strategies teams that report in at the very highest level of the organization seems like a great idea to me. So if you're accepting that changes is going to happen in every industry and probably faster than you think then having a team who wakes up in the morning thinking about how to take advantage of the changes that are happening in your industry whether it's health care or anywhere. I think that's an investment that pays off great dividends.

Saul Marquez: [00:25:16] It's a really great insight. And finally what's the one area of focus that should drive everything else in your organization.

Shakil Haroon: [00:25:24] I think it's about execution. At the end of the day if if you've got the right teams focusing on the right innovations and betting on the right innovations then it's a question of well how are you going to actually make it so. How are you going to ensure that all of these informations get delivered at the right quality and at the right time. So having team very focused on execution and reporting out on their progress versus versus your organization goals I think that's absolutely critical. We can all have the best ideas in the world and be philosophically bought into change in all of these new concepts. But if we're still sitting around a year from today with no progress to show for it well it doesn't really matter a whole lot. So at the end of the day it truly is about executing and taking action. I think certainly our organization as a start up are very much focused on that and I think that's probably true across the board.

Saul Marquez: [00:26:23] That's a great message and Shakil, what book would you recommend to the listeners on the syllabus.

Shakil Haroon: [00:26:30] Well maybe go off on a surprising tangent here in that it's not a health care book. My upbringing overseas makes me relate to writers with similar background. In this case one of my favorite books of all time is love in the time of cholera by Marquez. Wonderful book actually deals with a lot of themes that entrepreneurs have to deal with solitude sticking through it for years and years and decades and in some cases yeah but not a health care but it's certainly a personal inspiration.

Saul Marquez: [00:27:00] I love it. It's a great recommendation and listeners all the things that we've talked about today the syllabus that we just created for you. The book links to Shakil's Web site. All of them could be found at That's S H A K I L you'll be able to find all the show notes the syllabus as well as links galore. You'll be able to do that and so no you you not to write. That's why we do this for you to make sure that all this stuff is found easily Shakil, before we conclude I would just love to hear a closing thought. And then the best place where the listeners can get a hold of you.

Shakil Haroon: [00:27:36] Know well you know closing thought is health care. We're going through profound change consolidation. And it doesn't look like the end is in sight. I think accepting that we are all in this together patients providers payers and accepting the transparency and data is going to be the guy to our future in a future where we all drive both in terms of health as well as financially. Those are the thoughts I would have in closing we have an exciting time ahead. But again for those organizations that are capable of adapting so nothing that I haven't seen in any industry which I've been investing in both career as well as financially the ones that get out on top are the ones that are best at adapting to the change that is happening. Exciting times in healthcare. I look forward to getting the next wave of change.

Saul Marquez: [00:28:28] And Shakil what's the best place for people to get in touch with you.

Shakil Haroon: [00:28:32] Best is email So look forward to hearing from your listeners.

Saul Marquez: [00:28:42] Hey Shakil thank you so much. I know you guys are definitely doing a lot to ramp up the accountability for outcomes so keep up the awesome work. Well they're going to be filing what you guys do. And again I want to thank you on behalf of the listeners for sharing your wisdom today.

Shakil Haroon: [00:28:59] Appreciate the time. Good luck to you.

: [00:29:04] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Love in the Time of Cholera

The Best Way To Contact Shakil: 

Mentioned Link/s:

Episode Sponsors:

Healthcare Podcast

Patient Outcomes