The Healthcare Disconnect: Use of Digital Technology and Data for Better Patient Experiences and Care

(00:42)

Jas:
Today we’ll be exploring how we can utilize technology to better serve humanity in an area that is precious to us all, our health and wellbeing. All lives have equal value. So how do we reduce and ultimately eliminate inequality and how can technology help us to do this? Our panel of experts will share their views on how do we leverage technology and data to educate, to better inform and support healthcare professionals and patients? How does this make quality of health better? And what do we know by understanding data and making it actionable from a population point of view, as well as from an individual point of view? How can we use digital to provide better access to care and better patient care overall? That seems an awful lot to cover, but I promise you, the panel of experts will get us through this. And now to my amazing panel, Jean from Digital Surgery, Stephen from Microsoft and Paul from Inova Cancer Institute. Paul, can I first ask you to introduce yourself and just give a little bit of brief background on what you're passionate about.

Paul:
My name is Paul Bajaj I'm based out of Washington DC at the Inova Schar Cancer Institute. I'm the chairman and medical director of the Radiation Oncology, Division of Cancer Center. I specialize mainly in clinical care of advanced head-based cancer patients. And so I have a lot of research interests surrounding that. Outside of that I have many interests rather than broad-based both in government relations as it relates to adoption of new technology in healthcare. And I advise some companies on healthcare-driven initiatives that have to do with data acquisition of medical devices. And I also work on a project in China called E-health Now that's a second opinion oncology service that's helping to broaden the scope of care within our partners' networks there.

Jas:
Thank you. Jean, can I get you to do the same please?

Jean:
Yeah, thanks very much for having me. So my name is Jean Nemi. I was a surgeon and training trainer in college. Did my masters in social care and technology and ended up doing my training around London in Imperial. And then stepped out of surgery to think about surgery from a data perspective and a simulation perspective and an AI perspective for the last five or six years now. I was also a co founder and CEO of a company called Digital Surgery, known for a product called Tech Surgery and Training Tool. And that's recently become part of the Medtronic family. So, we became part of Metronic just earlier this year, which we're very excited about, and in the robotics division.

Jas:
Thank you. Stephen?

Stephen:
Yes, thank you for the opportunity to be part of this. My name is Stephen Docherty. I'm the industry executive for health at Microsoft. Prior to that, I was the Chief Information Officer for a large Mental Health Trust in London, South London and Maudsley. I was there for four and a half years. But I do have a tech background. I've been in technology for over 30 years. And I guess I've been fortunate that I went from technology into health, and now I can do health technology. So that's what I'm really passionate about.

(05:06)

Jas:
Jean, you started with a very bold mission for Digital Surgery, delivering your safe surgical care for patients around the world, can you just expand on that? What was the purpose and how did you start that, and why?

Jean:
When you say it that way it is very bold. Bold and humble though, because training in surgery and being at the kind of frontline clinical care, you get to see firsthand some of the inefficiencies and the variability in clinical care. And so I guess, a lot of our thinking in the early days was ‘is there a way to try and build some level of consistency and reduce variation of some of the clinical practice that exists?’ And if you look at surgery, the way that people become surgeons is that they acquire knowledge over a period of time by training in different centers, they get different exposure and get different opportunities to develop that case knowledge and that case volume. And so, variability in knowledge exists, and variability in training experiences exist. And our thinking was, is there a way to try and take surgery and then approach it in a very formulaic way, break it down into a data structure and a data format? And level one was, could we use that as a tool combined with simulation to train surgeons and support training. And so we released a simple mobile application called Touch Surgery, which was a training tool step-by-step. Surgical steps in your phone, virtual, interactive, we got some really incredible colleagues to join us from the world of gaming and the world of design. So, a really multidisciplinary team approach with different skill sets, to try and think about how to make this tool and solution. And then over time, we ended up finding incredible people who are motivated behind the mission and really focused on trying to solve some of these problems. But I guess, in summary, for a lot of folks, getting exposure to a problem, and deeply understanding the problem and wanting to try and fix something and make something better, I guess, is a deep motivator for me.

Jas:
Thank you for that. And I also understand that obviously, data is playing a greater and greater role, and also you're pushing it into use of HoloLens as well. So if you can just elaborate on that slightly, that would be great.

Jean:
Yeah, for the little piece I just kind of give you a bit of analogy. And, I'd love Paul to reflect on this as well. But the incredible thing about healthcare and medicine is that it's really a human driven speciality still, and there's lots of knowledge out there. But intrinsically, a lot of that knowledge is residual in these minds of experts. Right, and so what the healthcare system does, is it trains these incredible experts who become incredibly sophisticated and specialized in having pattern recognition and being able to do these incredibly difficult tasks, and then along the way, a couple of juniors come along and they try and train them. And then these experts can eventually retire and go on to kind of fruitful grass outside the healthcare sector. So if you think of that, from a data perspective, as a data problem. Fundamentally, what you're saying is you create a huge amount of data, and you optimize that data and models, and then what you do is, you take away that entire hard drive and just put it away. Before you'd find somebody who has magically through observing his hard drive at work, download it. And so fundamentally, addressing this problem of data within healthcare systems and how we think about data and how as specialists all of us get together around kind of, creating longevity in that knowledge and that data will be exciting. Now, the HoloLens for us was an incredible and interesting device, 'cause what it brought was a visualization tool and a compute system that could be hands free. So very similar to mobile but on somebody's head, it's like that transition from holding a phone to having information in your eye. And the question for us was always, that step change in form factor: how is that gonna impact delivery of information in healthcare? And so we tested it, obviously in surgery we wanna try and be hands free, and that was our thinking around ‘could you use a visualization framework and a compute device that was hands free?’.

Jas:
Thank you. Stephen, I know that you've been doing some work also with HoloLens, particularly in the current climate of COVID. Can you just expand a little more on what you've been using the HoloLens technology for?

Stephen:
Yes, yes, I was fortunate enough to meet the team prior to COVID happening, so I got to know what they were up to. The thing is that it was reported on BBC News two weeks ago, so our HoloLens team were already working with the team at Imperial College Healthcare in London, and the use of augmented reality and teaching doctors and surgeons which Jean referred to a second ago. However, in March, they realized that the hospital was starting to fill up with COVID patients. And protecting their own staff was becoming a challenge, especially with the huge rise in the demand for PPE across the sector and globally. So James Kinross who's a consultant surgeon and senior lecturer, he worked with our HoloLens team to deploy what's called Dynamics Remote Assist. And what that did, is it takes advantage of the the hands free telemedicine capabilities, but most importantly, it can be used whilst you're wearing PPE. So the good thing about it is other multidisciplinary staff could see exactly what was going on in front of the patient, but they’re in another room, so they're not having to wear PPE. So it's a really good story. And they were saving between 100 and 400 sets of PPE, depending on the size of the ward every week. So it's a really good story. And we're working with them now subsequently to look at how can we scale this capability across the country?

(12.32)

Jas:
It's very relevant in our current climate. Thank you for that, Stephen. Paul, I know that we spoke also about these additional technologies to better inform decision making. Can you tell me just a little bit about that, Paul and what you're doing in that area?

Paul
I do some advisory work for medical device start-ups. And the question that always comes up is how do we make use of the data that's being created for medical devices? And how do we integrate that into more personalized and shared decision-making between patients and providers. And the one thing I'm really passionate about, and that I hope that more companies during this explosion of digital innovation that's very patient centric, is that they have a broader lens on who the end user is gonna be. So you have one side where the patient is collecting that data, but then you have the other side, we have healthcare providers that need to utilize that data. And if you take it from the perspective of the healthcare provider, in most cases, there's numerous reports that talk about how the broad application of electronic medical records has led to somewhat of a depersonalization of care where physicians are just facing screens the whole time. If you talk to many health care providers for an average 30-minute visit, they may spend somewhere between 10 to 15 minutes of that visit aggregating data from various sources before they open the door and go and see that patient. And so I think from the end user's perspective, we have to look at the other end of the spectrum to the healthcare provider and say, "What are the needs on that end?" And many companies are looking to create this vast amount of data, but if it's not being aggregated and coalesced in a manner that's digestible, it's useless. And so really, I think the long term solution here, is going to be that start-ups and innovators in this space, really need to look at digital technology and data kind of in a 2.0 lens and say, "How are we going to integrate this, so that it's not an additional burden to the end user from the healthcare side? And then how do we implement the utilization of this data in conjunction with AI where we have smart alerts” and things like that. So that we're not just having healthcare providers not just providing care but combing through through data. And I really think needs to be the next phase of innovation in this practice.

Jas:
Thank you so much for that. I think a lot of people talk about data and the use of data. But I think exactly as you said Paul, it’s what you do with that data that's going to matter. And it's going to have to have a benefit. And I think the people that can decipher that and make it real and do something with it are going to be geniuses, absolutely. I just wanted to pull you back in Stephen, and just ask the question on, I know that the NHS is also looking at data from a population point of view and they’re looking at being able to predict and cure or even prevent conditions. Can you just talk a little bit more about how Microsoft is going about that?

Stephen:
Yeah, we're talking to NHS colleagues about how we can help them to go after the holy grail, if you like, of Population Health Management. And what we mean by that is, how do we join up the data? So going back to Paul's point, how do we join up the data from multiple sources such as Genemics status such as Genomics England, we are sequencing whole genomes. How do you join up that with the electronic patient records, patient reported data which could be mood, food, drinking, and patient generated data, all of which you can perform a sort of digital triage on, but the whole idea is if you can aggregate these sources of data to form a longitudinal view of the person, and then from there, we can start to apply the smarts for prediction and prevention of ill health, but also to allow people to self-manage their health through insight and behavioral nudges. So the other thing is well, as we know that health inequalities exist, and life expectancy, just in London, different parts of London are several years difference, and across the country, but by having the full mentioned capabilities, we can help the local integrated care systems of which the UK is being made up of (ICS’s) to deliver campaigns, to help target specific problems. And it happens in small pockets, but we're aiming to work with the NHS to feel this up.

Jas:
Yeah, can I just ask a question, Stephen, In that space, what's the role of pharmaceutical companies or do they not have a role?

Stephen:
Oh, yes, Pharma definitely have a role and we work with Pharma and they're actually at this point in time, they're working a lot of the testing capabilities. So we've got very strong partnerships with Pharma, because if you work with Pharma, the idea is that they want to start to create digital twins, because digital twins, using genomics data and other data will help them to test quicker and find medicines that’ll go after some of the disease burden that we have today.

(18.30)

Jas:
Paul, we previously talked about the sort of disparities in care delivery and how do we go about democratizing health for all? And can you just talk to that a little bit about how data could essentially focus in that arena as well?

Paul:
So I can certainly speak to it from both the data side or, in this case, the technology side. So when we think about disparities in healthcare, we can think about health disparities and so these are things that tend to be more epidemiological or social such as incidents, prevalence, mortality. And then what I like to think about it is from the aspect of healthcare disparities and so that's where we get into things like quality, access, appropriateness of care. And all of these really have an economic umbrella that sort of ties them together. And so speaking from the perspective of an oncologist, I really wanted to see well, what are ways that we can alleviate these disparities as it comes to cancer care.

When I was at John Hopkins, I would often see patients that would see me and I was maybe their fifth opinion, and they were gonna travel to Chicago, and to Houston, and to San Francisco, and to New York and gather all these opinions and from a cancer perspective, you're thinking to yourself what an inefficient way to render care, but then also how unfair that not everyone has the means to be able to do that, the time to be able to do that, the resources. And so I really approached it from kind of the second opinion front. And so I'm part of a company called E-Health Now, which was actually formed by myself and a group of really smart people younger than me from Warden. And so they sort of took a concept that I had thought about many years ago at Hopkins, and really made it where they triangulated the second opinion where you may have physicians who aren't able to provide that expert level of care, you have physicians somewhere else that are able to provide it, you have the patient in the middle, and so how can you without being burdensome to the patient triangulate these three parties in such a manner that you can actually affect their care and their outcome? It turns out when a second opinion is sought that care changes about 25 to 30% of the time, which is pretty significant. And that most people, if we're diagnosed with cancer about 90% of them would want a second opinion, but 95% of them would not want to leave their home to get their cancer therapy.

E-Health Now essentially was launched as a B2C prospect where consumers who needed that opinion and needed to do it in an economical manner, could do so, and we would triangulate a provider or providers with expertise with their care team at home, in a manner that they could continue to get really expert level care at home. And that there were some concerns that, could this be adversarial in some way, it was more than collaborative and so much to the point that it actually grew into now what is what is more of a B2B platform where we actually have hospitals that are coming to us to say, "Hey, we would like to make you part of our standard process and care delivery for cases which are more challenging and that helps to build the expertise and the reputation of our own hospital staff." The second level to that is that we now have pairs in private insurers that are now approaching us saying, "Hey, maybe this is better for our covered lives, because this has the potential to improve their outcome." So, I'm really leveraging from the perspective of we can minimize that care differential when it comes to guidelines-based practice. We can use collaboration and at the end of the day, you get better outcomes for the patient. And I think this type of platform where you triangulate experts with local teams, really has the perspective to spread across specialties and really way beyond cancer.

Jas:
Yeah, I think that that's wonderful. I think that's exactly where I think we need to get to, and I think this is Jean somewhere where you're also looking at, is how do we get an objective view on surgeons?

Jean:
Yeah, I mean, the more objective that we have within healthcare models and healthcare systems, the better. We’ve all seen that move from medicine being the application of an art to it becoming evidence-based. And I think the next layer will be a much more data driven connectivity driven healthcare system, and that step change I think we're gonna see more and more of that happening. So, I think it's gonna be pretty exciting. I think the demonstration from COVID that healthcare systems, do really need a lot more infrastructure that is data and digital and connectivity-based I think has been clear globally. I'm excited to see this next decade of healthcare evolve.

Jas:
Yeah, that's excellent. I mean, I'm really excited by it too. And also just about how can we actually make sure that anything that we're doing to benefit humanity is actually on a global scale, rather than just within our shores in the Western world as well. 

(24:33)

Jas:
So my last question to all of you is, if there was one thing that you hope technology could do for humanity, what would that be? And I'm gonna start with Stephen first.

Stephen:
At Microsoft, our mission is to empower every person and organization on the planet to achieve more. And for me, I'm fortunate to be in this position. But what I would like to say is we are living longer lives, and we will have a huge shortage of healthcare workers, the World Health Organization states that by 2030 will be 14 million workers short globally. What I would like to see with the technology and sequencing of DNA that we can, understand the disease signatures better, we get better prediction and prevention, and ultimately give the world not just longer but healthier, longer lives.

Jas:
Perfect, Jean?

Jean:
I mean, I agree with what Stephen said, I think that humanity can do a lot for humanity right now before technology does anything for humanity. But what I'd add is, in the spirit of building technology in humanity, doing things for humanity, I think the thing that I've learned is getting really incredibly talented people around a table or a virtual table to discuss and solve problems with technology, I think is incredibly exciting. I think there's a bridge, I don't think technology will solve everything. But I think, layering technology into what we do to make things easier, to make things faster and more efficient, is gonna be hugely successful for healthcare systems.

Jas:
Perfect, Paul?

Paul:
I wholeheartedly agree with what they've said. But I think the only thing I would add, is that we just need to make sure that as technology expands within the healthcare space, and to patients and to providers, that we need to continue to look at what is the humanistic aspect of how care is delivered, and how we deal with people because at the end of the day, me being able to hold someone's hand or just comfort them during a really difficult time. And I think any physician or healthcare provider could say the same, that there's really no replacement for that. There's no replacement for the touch aspect of what we do. And we need to continue to be able to integrate that without losing that.

Jas:
Yeah, I would totally agree with you on that. I think at the end of the day, there is a person that's there, that's wanting your help, or our help to make them feel better. And they our either our brother, our sister, our mothers, our fathers. So it's really, really important that we don't lose that human side of it. 

(27:47)

Jas:
There is a question that's come in and I'm going to just quickly read it, it's to all the panel so, it's from Melissa Delsonour. She says, "Digital and tech has the potential to increase the inequalities in health for a large proportion of the global community who do not have access to these luxuries. Should every organization responsible for accelerating these advances also be responsible for ensuring no one is left behind?"

Stephen
I'll have a quick go at that one, and I would say absolutely, yes. And we recently launched a campaign AI For Good. And that's to enable people to access perfect medical services in remote parts of different continents etc. So it's a large campaign that we've gone after because, yeah, it's our responsibility.

Jean:
I think the way that we think about technology should be a function of scale. The fundamental kind of thinking and modeling should be, how does this drive scale? And unfortunately, currently in healthcare service systems, scale isn't what we designed healthcare systems to deliver yet. And, again, COVID is an example of healthcare systems globally having to figure out how to quickly scale to meet the demand that a virus generated. So I think, thinking about technology as a means to facilitate scale, and one kind of tangible example is, there's already telehealth, which has been around for many, many years, and then all of a sudden, everyone’s realized, "Oh, hang on, I can call a doctor. Wow, that’s changed my life”, and that's changed access. So it's a great question. And, absolutely, I think it should be at the front of everybody's thinking from the founders of start-ups to also the folks who are capitalizing and funding start-ups and to the folks who are using it.

Paul:
And the only thing that I would add that I think absolutely, yes, and I think it is a responsibility to some degree of governments to have digital partners and long-term scopes in terms of integrating these types of technology to underserved populations that are their taxpayers.

Jas:
Thanks so much, Jean, Paul, Stephen for joining me today. I've thoroughly enjoyed having this discussion with you. And I hope that we go on to ensure we're delivering technology for better health and better outcomes for human beings and humanity.