Dr. Peter Chai, Emergency Medicine, Medical Toxicology at Brigham and Women’s Hospital

Wearables, Biosensors and Mobile Behavior Intervention with Dr. Peter Chai, Emergency Medicine, Medical Toxicology at Brigham and Women’s Hospital

: [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] Welcome back to the outcomes rocket podcast where we chat with today’s most successful and inspiring healthcare leaders. Visit us at outcomesrocket.health/reviews to leave a rating and review for today’s podcast because we have an outstanding guest. Once again his name is Dr. Peter Chai. He practices emergency medicine and medical toxicology at Brigham and Women’s Hospital. Peter has done a lot of research to develop and work with digital health innovations from ingestible sensors to measure medication adherence real time behavioral interventions to respond to disease. Wearable telemedicine and centralists detection of the biometrics. He’s done quite a bit has a lot of publications and I’m so privileged to have him here on the podcast Peter. Welcome today.

Peter Chai: [00:01:05] Thanks for having me.

Saul Marquez: [00:01:06] It’s always a pleasure to have a talented man like yourself that’s into the future of medicine and wanting to make things more efficient. What got you into medicine to begin with. Peter.

Peter Chai: [00:01:16] I was kind of always interested in the kind of human aspects of health. And after college and I also did a masters a lot of my interest was how you can really design different aspects of how to improve the way that patients and physicians interact with each other. And so a lot of my very early work when I was at Brown we worked a lot on the basic science and looking at how to design better petri dishes for cell culture and kind of from that experience I learned that you know that design is a new relatively new thing within medicine and also very important in developing these new interfaces. And given our digital health revolution the increasing use of smartphones wearable devices and all that there’s a real opportunity for Officer missions to really start to innovate in this area. So that’s really what got me into medicine and the work that we’re doing right now.

Saul Marquez: [00:02:10] That’s fascinating and the design aspect was the magnet that got you in and now you’re your full force going at it. What do you think today. Peter is a hot topic that should be on every medical leaders agenda. And what are you guys doing to address it.

Peter Chai: [00:02:25] I think from a digital health perspective the hot topic is really how to implement and operationalize things so you know that there’s so much research and there’s so many new technologies and devices out there. But then you look at kind of the healthcare landscape and what we actually do with patients in kind of the day to day clinical setting. And you notice that we don’t really use them much additional how there might be the sporadic insurance group that is using a system to track kind of movement health among large populations or you know there’s kind of nascent telemedicine but if you look across the broad you know thing is really starting to implement. And so a lot of we’re working. So we kind of work on two angles. One is how do you take any kind of innovative new topics that we know were and how do you scale them to a larger hospital. So for example like our organization and then the other part is how do we look into the future so we don’t stop at the cool new there. But let’s look at the thing that’s going to be popular in the next five to 10 years. Let’s get a physician and a patient perspective on it now so we can start to build back to when our system is ready to accept something like that. We’ve got the know how and the technology.

Saul Marquez: [00:03:34] Yeah that’s interesting and so. Are you still at the bedside or are you mainly focused on these technologies and implementation.

Peter Chai: [00:03:42] Well both. So I worked politically as a physician so I know where we’re at the bedside every day here where.

Saul Marquez: [00:03:48] That’s outstanding and you know the challenge of implementation. The technology is there but it’s implementing it into the system that and that is the challenge. What advice would you give to both companies and also providers wanting to get technology to make things better. What advice would you give them to help them do it more successfully.

Peter Chai: [00:04:09] So from a provider after you have a provider myself I think the important thing is to have an open mind. I think physicians are where a lot of us are trained to say no to a lot of things you know like there’s no evidence for that or this can’t work. And it’s kind of refreshing when you work with these startups and engineers and when you Athens’s the same question about you know could this work. The answer is never know it. You know. Think of a way to do it. You know it might be but there’s going to be a way of someday to do it. And I think the ability to kind of have that kind of foresight and the willingness to work with something that is imperfect is really important for a provider asset from a company perspective. The thing that we’ve really been trying to pushing is a really safe investment. You can’t there’s a healthy not cheap right. And our effort doesn’t come. We were trying to do the best we can for patients but there’s so many limits would appoint a full time research funding and all the stuff that I think the most successful company that I’ve worked with are the ones that really get that and are willing to think that you know put them in in the game and really work hard with provider champion I guess to kind of get things wrong.

Saul Marquez: [00:05:16] Peter give us an example how you or the organization you’re with have created results by thinking and doing things differently.

Peter Chai: [00:05:24] Sure. So I’ll tell you about a project that we’re in the middle of right now five or six months ago we started working with a company named visible who is repositioning Amazon Dash Button for harvesting. So you know they asked What will you put on your surgery or the button and the orders mail from Amazon. Well we’ve kind of pivoted the idea you know how to streamlining the hospital operations using just the time of the occasional so the simple button. So we’re working through a various amount of systems with our housekeepers in terms of doing things that are simple and kind of mundane like cleaning the restrooms in a hospital. That’s the big passing itself to turning over beds so that we can be more patient more efficiently and decrease the patient wait time. So the company very excited and very very innovative and helpful with us. We’ve got a pilot undergoing in three months. We’ve got some interesting results that we’re still gathering data for but we’re almost ready to take the next step already. So it’s really kind of the synergy between a company and kind of a forward thinking healthcare system like ours that really has been a catalyst for all of us.

Saul Marquez: [00:06:29] Yeah that’s super interesting and I think it’s these process innovations. Peter you know I see you as well as you know Brigham and Women’s definitely forward thinking and open to these things and I think the number of systems starting to be more open to process improvement. Like you guys are increasing. For example I was out of health care where we were doing a refinance on the House and we’ve refinanced with PNC Bank and then we recently refinanced with Quicken Loans. Have you ever used Quicken Loans. They have Mateschitz. Oh my gosh. So when you do the refinance through them everything is a sign everything is just so fast. It happens in like I don’t know. Like literally like two weeks compared to like three months that it’s like with a traditional bank. And so I envision what you guys are doing like the Quicken Loans you know for process improvement that will help outcomes and that’s really exciting.

Peter Chai: [00:07:24] It’s super exciting to be kind of in the thick of it because you like one day you literally like walking to the bathroom with some gorilla glue and taking things on the wall and the next day and looking at alchemy and dynamic stacking models of leadership.

Saul Marquez: [00:07:41] Yeah that is so so interesting and I’m excited to hear how that turned out. When are you guys expecting to finish the project.

Peter Chai: [00:07:47] I think with about 3 3 months or so we’re we’re working on a few publications that hopefully will be coming out and some abstracts that there’s going to be I think one at him comparable to yours both yes awesome stuff.

Saul Marquez: [00:08:00] Well at the end when you’re done maybe we’ll have you back on to chat with us about what you guys found. They’ll be really interesting.

Peter Chai: [00:08:07] Sure.

Saul Marquez: [00:08:07] So share with us a mistake or a setback that you guys have had while trying to make things better and what you learned from it. More importantly.

Peter Chai: [00:08:15] I guess from a digital health perspective one of the setbacks that we’ve had before is really trying hard but then you know having the project fail at itself and know that in itself is kind of a learning opportunity. So we’re thinking about working with a small startup and using a novel device to kind of get real time patient lab data and be allowed to work with that kind of writing proposals and doing all the stuff. And I think the problem that we didn’t think about is we didn’t have the foresight to realize that you know a lot of the investment in doing even the small pilot study well a lot of work and kind of we were in the thick of it for about a year before we realized Rondeau we’re doing a lot of work yet that is being done with nothing and we forgot about the budgetary aspects of it and you know nobody has funding to have a go have had that been work. So the project kind of fell through and has been a standstill. So I think at least for me we learned that there was kind of a realtime demonstration of invest time but somebody got to invest the resources within the project to really have to work.

Saul Marquez: [00:09:18] Yeah that’s such a great call out. I mean how many times have we listeners gotten started with something only to find out that there was a missing piece of the puzzle whether it be buy in from a clinician or resources like that Peter was just saying. And I think this learning that Peter sharing with us is so important to resurrect and to be reminded that we’re working in a complex system we’ve got to analyze the depth and the breadth of what it’s going to take and not go forward until we have a full picture of what it’s going to take. And sometimes we could get so excited right. I’m sure your idea is so exciting right Peter you just wanted to go for it.

Peter Chai: [00:09:54] Yeah. And sometimes you know it does it does pay to kind of take a step back or you know I think the other thing that people are so worried about is not having an NDA in place and then. So the cool stuff about a new technology but no I almost feel like the ability to I will when we’ve been most successful is we take this concept and we ask one of our colleagues who completely does not work and then say we say what do you think about and that kind of insight from somebody who is divorced from the entire idea now has not invested in it is actually really helpful. They’re the best ones that poking holes in the concept. And I’d rather not hold early them when we’re about to start.

Saul Marquez: [00:10:32] Such great great great words of wisdom there Peter and listeners definitely take these into consideration. What would you say one of your proudest leadership moments and medicine is.

Peter Chai: [00:10:42] I think probably one of our proudest moments was when I was a resident or Dame or rather see a brown in an emergency medicine in a 2012 Google Glass just came out and we got really excited at the department about can we really use this to become the next generation and telemedicine. And this was a kind of probably about a six month long project where we really took Google Glass. We are exploring their early Explorer program which is the technology we were to be a great startup that was super responsive to our needs and we worked together and built a wearable telemedicine program for dermatology in our emergency department. They find really a new wearable device new video stream. We learned about the older technology and the infrastructure support you need to build bring in something like this in a hospital. You know no one in our hospital knew what to do with wearable smart glasses you know where were categories have in within the information security standpoint. So it took us Galong six months for voice through all these regulatory bodies but we’re able to do a pilot study. We are published in JAMA. So it was really I was really proud achiever cheaper for us. I think that was one of our first real big within days.

Saul Marquez: [00:11:56] That’s so awesome. And thanks for sharing that story. It’s that vision. Peter you obviously got a vision right. I mean you’re in this for the long haul and I’ve read recently that Warren Buffett even it took him nine years to become a millionaire. And oftentimes people just look at folks like Warren Buffett or you know successes that are had like the one you experienced with this project in the E.R. and they look oh wow you know what happened overnight. But the reality is it happens over a long period of time. And Peter and his team took a while to get this done. And the same for our system. You know it’s these small wins if we continue having we will transform the system. Wouldn’t you agree Peter.

Peter Chai: [00:12:37] Is a great point. It’s really those little kind of small steps and you know as an emergency physician I’m probably the worst at that because we live in the moment we live emergency care. So when people are like well takes like four months or you know to go to our CEO to make sure it works. I just cry a little bit Gosh but then you realize that you know like wow that was like five years ago we started that and look where we are now and that it really I think for people who are just starting you know tell them anything you want about how exciting it is and how much progress we’ve made over the past decade or so. But you really don’t need at the very beginning and there’s really you know you really start to appreciate the shoulders of all these people that you’re standing out once you kind of move forward a little bit.

Saul Marquez: [00:13:22] Totally. That is such a great point here. Keep doing what you’re doing every project that you take. It’s iterations on the previous years that you’ve been working on this. And I just encourage you to keep doing what you’re doing because it’s so awesome. And I bet like 10 years from now you’re just going to not stumble but finally get into something that really just pivots and changes things for the entire industry not just your your idea. I mean you’ve definitely been doing a lot for your ID. But just the way I see you developing and the way that I see you doing things you’re going to be doing some cool stuff man so keep keep at it my friend.

Peter Chai: [00:13:55] Thanks. We prefer to call it that.

Saul Marquez: [00:13:56] But a bad ass is good. I like bad ass. Hey so tell us a little bit about a project that you’re working on today.

Peter Chai: [00:14:06] Sure. So what happened is that we’re really interested in is medication adherence. So we’ve been doing some work on the adjustable biosensors so these are off the shelf gelatin capsules. They use a little 3D printed circuit with a radio frequency embedded attached to it and the kind of magic in it that you can compound it or over encapsulate any kind of drug that you want to study with it using standard filtering machines that most all pharmacies have. So when patients ingest these medications chemic at the end of gel capsule like any other gel capsule medication that’s out there and Corneille your stomach actually activate active power and activate radio frequency better. I would take that signal up with a reader that the patient wears. So you get real time direct measures of medication ingestion. Certainly we’ve never been able to do before so if you look at kind of direct the direct measures of adherence before this digital health technology it’s really a nurse going into someone’s house and watch somebody take their medication right directly observed therapy. So this take this transform is really how we think about it here. So one of our interest. I’m also a medical toxicologist so a lot of my work has been patients with substance use disorder and especially those with high risk for HIV. High priority in the high risk population who be happy to do it. So we’re about to start a study here in Boston looking at how patients who are at risk for HIV take Predix closure. So there’s a place where your policies grow Truvada that actually if taken daily can prevent HIV and Hybris people who knew you might get high. These drugs. Forget. Do something with me get infected. So this is a really good prevention method that really relies on it here. And so how do we get somebody who doesn’t really care about their health who is going to have a disruptive and unstructured life to take their medication every day on time. And I think this digital technology will help us because we’re going to do. So we were developing a study where we give patients visual pills you wash them how they take medication in real time and the really cool part is that you know now that we can detect it here and if you miss a dose that means that we can start to push interventions to people in real time in response. So we want to wait for people to show up to their doctor’s office and board. You know everyone’s got a smartphone less starts delivering health at the moment that or health workers. So we’re hopefully they’ll start soon looking at this project using digital pills and Chris Black.

Saul Marquez: [00:16:34] That is super interesting and and a project that I think will definitely tackle a big problem. And what we’re dealing with you know in any population with the elderly population you know a lot of them are aging and a lot of them have mental illnesses. How do you keep track of all this. Right. So yeah it’s a really really interesting idea. So as you guys move forward with that definitely maybe when we get the update on the other project we could hear a little bit more. I know listeners are probably like Oh this is so cool and so we’ll get an update don’t worry as long as Peter is up for it we’ll get an update for you.

Peter Chai: [00:17:06] Yeah we’re totally off are.

Saul Marquez: [00:17:07] Awesome. So Peter getting to the end here. This has been a lot of fun 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 of Dr. Peter Chai. And so we’re going to build a syllabus. I got four questions for you. That will do a lightning round style and then we’ll finish it with podcast that you recommend to listeners so your.

Peter Chai: [00:17:30] Alrights, let’s do it.

Saul Marquez: [00:17:31] Alright. What’s the best way to improve healthcare outcomes.

Peter Chai: [00:17:35] Like patients.

Saul Marquez: [00:17:36] What is the biggest mistake or pitfalls to avoid.

Peter Chai: [00:17:39] Forgetting that it’s just you. There’s more stakeholders then you expect to be involved.

Saul Marquez: [00:17:44] How do you stay relevant as an organization. Despite constant change.

Peter Chai: [00:17:48] Look to the future. Always ten years into the future don’t don’t be okay with the cool things that are happening now.

Saul Marquez: [00:17:54] What is one area of focus that should drive everything else in your organization.

Peter Chai: [00:18:00] Integration of technology digital health and data storage.

Saul Marquez: [00:18:03] And what book would you recommend to the listeners or what podcast.

Peter Chai: [00:18:07] Good question. Well Aracataca at the core. From an entertainment perspective there is a medical toxicology podcast that tackled head of tox dilemmas. Within all across the world cup a Dantastic Mr. Tox Show which I highly recommend.

Saul Marquez: [00:18:23] Very cool. Very cool. The Dantastic Mr. Fox show.

Peter Chai: [00:18:27] The Dan tastic has been is one of the people that does it.

Saul Marquez: [00:18:30] Got it. The Dantastic that there you have it. So listeners go you’ve got the podcast that you’ll see in the show notes will provide a link to that as well as the syllabus that we just crafted here for you with Peter and also the show notes for the entire show that we just discussed here. Just go to outcomesrocket.health/Chai that C H A I will be able to find all that there. So Peter before we conclude I’d love if you could just share a closing thought and then the best place where the listeners could get in touch with you or follow you.

Peter Chai: [00:19:04] In terms of closing thoughts. I think we are all kind of at this amazing point in health care where we have the opportunity to really change the way in which we deliver health. So there’s no idea that’s too stupid or too far out there. I see my share being that people think are crazy that are now clinical practice so don’t be afraid to go forward. Best way to get in touch with me is probably either at Twitter or via my email which I think probably be provided in the links somewhere. Right.

: [00:19:35] Yeah. All right well there you have it listeners thank you so much Peter for spending time with us today. I think it will definitely be interesting for us to digest all the nuggets of wisdom you provided and looking forward to having you back on.

Saul Marquez: [00:19:49] Thanks. Thanks for having me.

: [00:19:53] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.