: [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 outcomesrocket.health/reviews 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 outcomesrocket.health/drkeith 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 http://www.drgrimes.co.uk/ 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 www.outcomesrocket.health for the show notes, resources, inspiration and so much more.
Howard Rose – www.firsthand.com
Brennan Spiegel – https://www.virtualmedicine.health/brennan-spiegel
AppliedVR – www.appliedVR.com