Rae Woods: From Advisory Board, we are bringing you a Radio Advisory. Rae Woods: My name is Rachel Woods. You can call me Rae. Rae Woods: Today, I want to talk about the role of technology in the future of healthcare, and I'm going to try to thread the needle a little bit. We're going to be turning up the dial on how far into the future we're actually looking, and how much innovation could affect our industry, whether it's intended for healthcare or not. But I also want to make sure we're focused on what's actually possible by setting our sites on the next decade of healthcare. Rae Woods: To do that, I've brought digital health expert, John League, and strategy expert, Nick Cericola. Hey Nick. Hey John. Nick Cericola: Hey Rae. John League: Hi Rae. Rae Woods: We're going to be talking about technology. Is this something that you want to embrace? Are you one of those people who gets wary about being ultra connected and devices are listening? Where do you stand on on tech? Nick Cericola: John's an Alexa guy, right? John League: We have an Echo Dot that gets used predominantly to find out what the weather is today when you're too lazy to just go get your phone. I should probably be more concerned about privacy than I am, but I think that is where most people are. We only care about it when we perceive a threat and the things that are already sort of invisible to us, we don't even think about. Nick Cericola: I do not participate in voice assistant world yet, and I hope to avoid it for as long as I can. Rae Woods: I am an anti-Alexa household. I would however sign up for... If they come out with a fitness implant, like the Apple Watch implant, I would totally do that. I don't know where the cognitive distance is between Alexa and fitness tracking is for me, but that maybe describes my personality a little bit better. Rae Woods: There is so much talk about tech in healthcare, but I'm hoping that the three of us can turn up the heat on what it means to be thinking about technological innovation. I want to leave telehealth aside. I want to leave the digital front door aside, and talk about what is really possible, say, a decade from now. Does that sound fair? Nick Cericola: Yeah. I'm in. I love thinking about the world from 2030. Rae Woods: Are other healthcare leaders thinking about technology and innovation in this kind of way? What are you seeing others report about? Nick Cericola: Rae, one of the things that I do read quite a bit about, or have seen numerous examples of, is the discussion of the smart hospital of the future. So I think it's pretty easy in conversations like this one, we're thinking what the world looks like in 2030, 2040, to start imagining these connected spaces that our hospitals today transition into, and I'm open to debate on this, but I personally am a little bit skeptical that we're really going to see the smart hospital become a ubiquity, a main stay of our delivery system, at least by the year 2030. Rae Woods: John, do you agree? John League: I do agree. I think it is possible, and increasingly likely that we will see what we think of now as hospitals or other facilities like that become more like hubs in terms of innovation and creativity in using technologies, either things that they are developing themselves or things they are adapting to their own uses. The example that comes to mind is Sheba in Israel, which has a lot of innovative programs and technologies being deployed as part of their DNA. I also think of something that is slightly more mundane than that in terms of the 5G network that Rush has in Chicago there on campus. John League: I think those kinds of things are what we are likely to see, but for the care experience of most people, I don't think in 2030 most patients will be visiting a super smart, highly connected facility as the center of their care. Rae Woods: And this is the balance I want to strike, right? I want to turn up the heat, but I also want to think realistically about, again, the next decade. And when I think about the future of technology, there is one goal that I would say is actually necessary for the healthcare space. There is not a single provider that I speak to that isn't hopeful that technology will finally unlock all the scale and all of the capacity that providers so desperately need at a high level, possible by 2030? Nick Cericola: Yeah, I think so. The acceleration in the use of digital health tools from the provider side is going to create lots of opportunity for scale. I don't think it's that outside the box to imagine that by 2030, we've got diagnosticians that are basically interpreting readouts from algorithmic tools or PCPs that are managing patient panels that are 5,000 patients plus, because of what technology, AI power technology in particular, allows them to do. And it won't be all specialties, but I think we're going to start to see it creep into specialties that maybe today are much more in person as far as the nature of the experience that a patient has. Rae Woods: And like I said, I think that in some ways this is a change that people are, I'm going to use the word desperate, for. Especially in some of the darkest moments of the COVID-19 crisis, we've realized how little capacity we have and how fragile of a system we have in terms of real people and real staff. But is there a downside to a singular focus on expanding capacity and using technology to do that? John League: Well, the downside is losing what we would think of as the personal elements of care. I think Nick is absolutely right, and I think it may be even stronger than that. I don't think that most providers can afford not to do this, not just in terms of a competitive sense where organizations who are not attached to a legacy health system are going to try to come in and disrupt existing relationships. I think that is certainly possible, but I also think that the things that we've done to address clinical capacity up to now have largely not been successful. John League: We still have these capacity problems. I think we absolutely have to use this technology because otherwise, we will never be able to get out in front of the problems that face us. Yes, there are risks to using these kinds of technologies. I think there are bigger risks if we don't use them. One of those risks that we have to address though, is when we talk about empathy in clinical experience. When we talk about, what is the nature of the relationship between patients and providers, and how do each of those ends of that relationship experience that in human terms? Rae Woods: And that's where I want to go next, because if I'm honest, I think we already have an empathy problem in healthcare. Providers aren't necessarily known for empathy, wonderful case studies and stories of good nurse to patient or physician to patient relationships aside. So if providers are even more abstracted from their patients a decade from now, are there actual clinical consequences for that? Nick Cericola: I think so. So Rae, you said empathy is something that we already struggle to find or create in the provider-patient relationship, but what I think we're talking about here in the world that John just described as something that we need to actually bring to fruition, is one in which the space for empathy to happen actually gets narrowed. Empathy can still happen when providers are seeing, talking with, touching, sensing, listening to their patients, virtually or in person, in a world where decision making actually happens more on the basis of algorithmic outputs. And in a much more remote capacity, I do think that could have a clinical impact because we already know that empathy not only serves the provider, who needs to understand the context for their patient in order to make holistic, culturally sensitive, appropriate treatment decisions, but we know that it's especially important for patients who need to sense empathy from their providers in order to develop commitment to the actions that are being asked of them in their treatment plans. Rae Woods: Give me an example of that, because I understand what you're saying, but I believe that maybe somebody in our audience might be struggling to make that leap of how empathy turns into better patient behavior. Nick Cericola: So I think on a very human level, having someone describe to us a course of action in a way that feels to us that it's reflective of our anxieties, our goals, our lived realities as we've articulated them to that person, I think that we're much more likely to not only listen to the advice being given to us, but to interpret that advice in a way that we feel is actually appropriate to our needs. Whereas if you're getting something transmitted electronically from an individual, or in some cases a bot that you've never spoken with, and doesn't see you and doesn't understand you, and hasn't even asked the questions to build that understanding, you might not take that medication. You might not schedule that follow up visit. Rae Woods: You might not even trust that outcome. Nick Cericola: Exactly. Rae Woods: You mentioned that this is important for the patient, but I also imagine that this is important for the human side of the clinical relationship. I know I just ragged a little bit on empathy among providers, but I also know that there is a big chunk of the clinical workforce who gets into healthcare because they want to work with people, because they want to lay hands on patients, and because they want to feel and see their patients get better. In a world where increasing means that healthcare gets much more transactional, do we think that people will still want to be healthcare providers at all? John League: I don't think it's so much about whether or not they will want to be providers, I think it's more a question about who will want to be a provider. It's not necessarily the same kind of people who want to be delivering that care through these same channels. That may solve the problem of capacity by expanding the pool of people who are interested in doing this work. I'm not saying that that's a guarantee, but I think assuming that the future clinical workforce looks exactly like the clinical workforce does now is probably wrong and probably not constructive for the kind of healthcare that we need to be providing. Rae Woods: That's right. Nick Cericola: I agree wholeheartedly with what John just said, and I think to give maybe a little bit of color commentary that, or to animate what that could actually look like, I think there is a possibility that we see across the decade increased both demand for and interest in amongst potential clinicians roles that are actually built around the empathy question, where the clinical side of the work increasingly is owned by the technologies, by the AI, with oversight and input by the clinician, but the clinicians are increasingly in the game so that they can provide that human element. Nick Cericola: These are the individuals who you just mentioned, Rae, are really coming into the field because they want to have that interpersonal connection. But there could be a simultaneous track for new providers who are really animated by the numbers, who are eager to capitalize on the flexibility that a digital health labor force provides them. Where you can even imagine it becoming something like a gig economy that we have today, where you can sort of move in and out of different roles at different organizations and different capacities because the technology is a thing that's consistent. And the people sort of helming that technology and interpreting it and translating for patients can be a little bit more mobile or agile in how they do their work. Rae Woods: And this is a really important insight, because can't just be thinking about the conclusions that happen at the end of the decade, we also have to be thinking about the means to get there, and that's where the people who are listening to this podcast have a lot of power. Whether it's saying, we need to interject empathy training into these types of roles, or frankly, whether it's digital health companies, the tech companies themselves, that need to figure out how do we deliver human interactions in a more transactional world? And I have to believe that there are already companies out there that are focusing on that. Rae Woods: John, do you know of any? Nick Cericola: I don't know that anyone has solved this, certainly. It is something that they're working on, and I think there is a lot of work being done in artificial emotional intelligence, which sounds sort of disingenuous when you think about it. Artificial and emotional. But the idea is to encourage adherence scalably, by making an automated interaction with a patient seem better. Nick Cericola: There have been various efforts at this. There was recently a study though that a behavioral health chat bot run by Wobot was actually pretty good at creating a bond between patients and the platform, but I think that was largely because the AI platform was very upfront with patients about what it was. It didn't try to seem like it was impersonating a human, it was simply trying to create a relationship with the patient and give them information that they could trust. It was very upfront about its limitations and didn't try to be more than it was. And I think that's a good design way of thinking about how we approach what these alternatives, what these substitutes look like in the future. We're not going to replace humans, we just need to be careful when we're designing these platforms. Rae Woods: So we talked about capacity, which is a huge goal when it comes to the technology space, but the other kind of promise of technology that hasn't been realized yet but could be across the next decade is all about the internet of things. All this data that we get from the health tech marketplace through apps, wearables, implants, all of that. So far, my understanding is it's a lot of data and not a lot of action. What do you hope changes by 2030? John League: Right now, we're in a world where, to some extent it's data, data everywhere and not an insight to drink. What do we actually do with these streams of data? How do we serve up the important few out of the trivial many so that it gets in front of a clinician or a care manager or someone who can actually intervene in an appropriate way on behalf of the patient? How do we serve up all of the new clinical information that is being created every single day in a way that can actually inform care decisions to drive better outcomes? That's the real question. Rae Woods: And I imagine this is going to be harder because we're talking about a future where there's even more data. That data is more mainstream, it's more connected. Maybe it's even better data than what we're using today. But I imagine that the problem still has to be, how do we get people other than the consumer themselves to actually be the ones that are using and acting on that data? How do we get the clinical team involved? Nick Cericola: Yeah, absolutely. And to be fair, Rae, I think the industry does hold the ambition to shift some control to patients. We want patients to be in a seat of greater agency over their care management, and we imagine that the internet of things, which I think someday are just going to become things, because everything's going to be connected at some point, will become sort of the chassis on which individuals can make more informed decisions about their wellness or healthcare. Nick Cericola: We still want the clinicians to be a part of that paradigm, and I think getting the balance right is going to be really challenging. I already see a world in which we perhaps shift too much control away from clinicians and towards the internet of things to a point where we are less able to manage some of the risks that that creates. Rae Woods: I'm really interested in this idea because Nick, you're talking about the balancing act that we have to do between patients and providers. I might go a step further and call it a power shift. And we know that we've wanted to shift power away clinicians and to an individual consumer for some time. That is a good thing. But what happens if we go too far, and we swing the pendulum too much towards the end consumer and all of the new power that they have because they have so much access to their own healthcare data from the internet of things? Nick Cericola: So I want to tee up John here to answer this, because he coined a term that I have since fallen in love with. But before I do that, I want to add an additional participant here in this power shift, because I think what you're describing is really interesting, Rae. But let's not forget that there are companies that sit behind the internet of things that are larger not healthcare organizations. Listeners can imagine who I'm talking about. And they use the internet of things, our personal devices, to prompt us to do things in our lives Sometimes those prompts are in line with health and wellness goals, sometimes those prompts are in line with their own incentives to get us to participate in their ecosystems, whatever those are, whether it's commercial or social. And so I think as we shift control to patients vis-à-vis the internet of things, we have to remember, there are other actors sitting behind that that have their own interests here. But John, I want you to talk to us a little bit about the term that you've coined. Rae Woods: Yeah. John, you really got the tee up here from Nick. John League: Well, the thing that Nick and I were thinking about as we sort of explored this problem was thinking about the ways in which all of those different influences on the consumer, both from their access to their own data, but also from these outside forces, these other participants now in the healthcare ecosystem, to what extent would the things that the patient wanted to do or the recommendations that they were seeing, be it odds with what a professional care team was telling them? John League: I think it's not too much of a stretch, given all that we've seen over the past year or so of pushback against valid, scientifically grounded health advice given to patients, that they would potentially reject a lot of those things if it didn't fit their worldview. And what we started calling this is technological homeopathy. John League: So basically, home brew healthcare that is derived from what the patient is able to access through all of these new technological channels, through their connection to data, through their connection to other sources of information and influence outside of the patient provider relationship. What does it mean when patients disagree? When they feel empowered to debate medical professionals about diagnosis, about their health, about their treatment? I think those are incredibly important questions that we need be prepared for in a way that the largely paternalistic approach that most clinicians take to advising their patients is really not going to live very long in that world. Rae Woods: Okay. This is a wild idea to me, John, but I also love this term because when I think about what clinicians have to deal with today, and they have to deal with misinformation, and they have to deal with people who are saying no, this vitamin or this supplement or this essential oil is the thing that I have learned or that I believe is going to support my care, and we all know how painful that can be in the middle of a clinical interaction, but you're saying, what if it's not the essential oils and the supplements? You're saying, what if it's the technology? The very technology that we need to get us out of the problems that we face today. John League: For sure, and I think that just speaks to the unintended consequences of embracing a lot of these new channels for care delivery, for managing symptoms, for connecting people to information and even to other people. I think the unintended consequence element of it is something that we often don't examine enough. We're perfectly content to have a projection in 2030 that is all rainbows and lollipops, and we're able to achieve all of these great things, when the reality is that with all of these changes that will be for the better in many ways, there are also other ramifications that if we don't think through how we implement those things, we will wind up with other problems that we have to dig ourselves out of. Rae Woods: Let's go there next. We've talked about two big changes in healthcare that I hope are actually in the future 10 years from now, because to your point, they sort of have to be. But let me just take a step back and think about the future of a more technological world in general. Are there unintended consequences that you're worried about that you want to make sure the healthcare listeners, the healthcare leaders that are listening to this podcast, are aware of? Nick Cericola: We already know that digital hyperconnectivity brought about by smartphones, social media, et cetera, causes physical and behavioral health conditions. Depression, anxiety, sleep disorders, et cetera. I worry, what happens as the lines dividing digital spaces from real spaces become more difficult hold to identify? If we create new types of interfaces with the internet that aren't based on hardware, that are screenless as we transition what we know of as social media today to perhaps an actual metaverse where we exist digitally alongside our actual selves, I worry that that leads to more public health challenges and challenges that are more insidious because they're less readily identified both by those who have the challenge, but also by the care community that's meant to serve them. Rae Woods: And maybe the treatments that that care community uses. Nick Cericola: I think so. Rae Woods: John, what about you? Are there bigger, unintended consequences you're looking towards or wary of? John League: I worry about the trajectory we're on with cybersecurity. I don't think we take this seriously enough. I don't think we invest enough in it. And I think it will undermine the ability of healthcare organizations to continue not only to have the trust of their patients and their payers, but I think it could eventually disrupt their funding mechanisms. I think it could be that these attacks are just too sophisticated and just continue to drain resources if we don't take this seriously and start investing in the ways we should. And it's very easy to say, well, everybody just needs to invest more and we'll solve the problem. That is not the end of the solution, but it is the beginning of the solution, and I don't think we're there yet. Rae Woods: Well, Nick, John, I want to thank you for coming back on Radio Advisory. You've both speculated into what the future will look like, and now I want to turn to the here and now. What is the one thing that each of you wants our listeners to focus on when it comes to technology in healthcare, and maybe technology in our society? Nick Cericola: What I would say is that... And this is a good thing. A lot of technology shines brightly. There is so much promise in health technology and technology writ large and what it can do for society. But in shining so brightly, it makes it hard to see what's being pushed aside. We've talked about empathy. We've talked about connection to real people in real spaces, and for leaders in healthcare, leaders everywhere, individuals in all corners of our society. I think it's really important that we're not just making big calculations around technology's role 10 years from now, but that we are paying attention along the way to what gets shoved aside or eclipsed as new technologies take hold and are introduced into our lives and make sure that any losses are mitigated to the extent that we can, and that we use technology to bring those things back when it's important to do so. Rae Woods: John, what about you? John League: I would say that we want to avoid the tendency of using technology as a solution in search of a problem. There are lots of shiny things, as Nick said, out there and often we get so caught up in the potential that we tend to over hype what we're going to do. Estimates that virtual care would to take up 50 to 70% of all visits, or that AI is going to completely revolutionize cancer care within the next five years. Those are valuable technologies, but when we overstate what they're able to do for whatever reason, our own enthusiasm, our own commercial interests, what we wind up doing is potentially setting ourselves up for an actual tech lash, if you will. A backlash against technology, that actually makes it impossible for us to achieve any of the benefits going forward, because we don't get acceptance. We don't get adherence. We don't get buy-in, and we might even get disinvestment. I think that's probably one of the worst possible outcomes. Rae Woods: Well, John, Nick, thanks for coming on Radio Advisory. John League: Thanks Rae. Nick Cericola: Yeah, this was uplifting. Thanks Rae. Rae Woods: Yeah, it got a little scary there this time around. Nick Cericola: Sorry. You don't have to include that. John League: No, I think you do. Rae Woods: I think we do have to include it. That's right. Rae Woods: Whenever we talk about the future, I have this tension of being both excited and a little bit nervous. We should, of course, set our sites on big, bold, innovative solutions, and we need to think about preventing those downstream consequences that Nick and John mentioned. Rae Woods: But we also have to focus on this moment, and make sure that the technologies and the tools that we are testing actually work. Not just for our business case, but for the patients that we serve and for the workforce that will be using them every single day. Rae Woods: So remember, as always, we're here to help.