All right, hi and welcome everyone. We are excited to host this webinar today with ACC and MedAxium. It is our Care Transformation Initiative, which is one of the board initiatives of the American College of Cardiology. And we're starting by talking today about best practices for care delivery and implementation. This is based on a foundation document that you can find at the link below. And this is a foundation for integrating community-based care into health systems, just in general, as we think about where cardiovascular care delivery is going today. One of the main things we're seeing is the real need to deliver better care in the communities where people live. And so as we start to make that transition, this is kind of the foundation document and the beginning of a conversation we hope between us and you with feedback in both directions about how we can best achieve this for our patients and for our practices. So with that, I'll get started. Our speakers today, myself, I'm the Chief Innovation Officer at the American College of Cardiology, a cardiologist by training. By way of disclosure, I'm also the chair of the FDA's Digital Health Advisory Committee, but I'm not speaking on behalf of the FDA today. And Ginger Biesbrock, the Executive Vice President of Care Transformation and MedAxium, and she has no disclosures today. I wanted to start with just a little bit of background. When we are thinking about clinical guidelines, as we move forward, one of our goals is to really think about what a multifaceted approach looks like now that aligns with clinical objectives and patient needs. We've moved to a phase where scientific knowledge and clinical knowledge is important, but the delivery of care and getting that knowledge actually into practice with patients is the area where we need to start to focus. So that means that care strategies have to be tailored to and evolve with the clinical guidelines, ensuring that patients are getting the current evidence-based treatment, the rate at which these guidelines are changing, and the rate at which the opportunity to apply new science to patients is changing is significant. And so having an infrastructure is really important. We're also recognizing social determinants of health and drivers of health are such an important part of the care strategy. Drivers of health are such an important part of how our patients experience the world and how they experience health, that we need to integrate them into planning to reduce disparities and to improve outcomes. Recognizing all these things that we want to do, we also know that existing resources are feeling a little bit limited and we need to learn to use them strategically. So how do we create effective care in the modern cardiovascular practice to achieve these relatively new and multifaceted goals? And so together we'll talk today about how we can do all of this. It sounds like a lot, but there's actually a process to getting there. And so that way we really do build a strong foundation for implementing best clinical practices across a variety of practice setting. I'll start by talking about a couple of key areas that we think should be focused on. And then Ginger's gonna actually give us some examples of where this has already been done and how these key areas have transitioned into actual implementation. Social determinants of health, everybody's familiar, but we really have to think about programs that account for diverse individualized needs of populations. And these are the non-clinical factors, housing, food access, education, transportation, because they really do impact health outcomes. The most important part is to think about how do we proactively integrate social determinants into care planning rather than after the fact, think about, hey, is there a way now to account for this? And so that's really essential is the proactive approach to social determinants of health. That then requires us to have mechanisms to capture those social determinants or drivers upstream and ensure that they're presented to the clinical team so that they can take them into consideration as we're moving forward. Multidisciplinary team-based care is something that those of you who've come to MedOx and your ACC webinars have heard Ginger and I talk about for what feels like over a decade at least, but the team is changing. I think it's important to think about that because a successful model of care really includes not only the team as we often define it, which is the team in a hospital setting at the bedside or in an outpatient setting with the patient, but thinking not only about physicians, nurses, allied health professionals, but care coordinators, interdisciplinary expertise, who are the other people that we're dependent on in this setting for this patient? Also thinking about the patient when they leave our clinic or our hospital, who is the family member that they are closest to for their health needs? Where are the local organizations that they may be going to and could potentially engage in for local follow-up of care? Who are our pharmacist contacts in the community that may be able to help support these patients? And are there community health workers who can be skilled and trained in helping us understand when patients are doing well and when they might need to come back to care? And so this approach now enhances the quality, the continuity, the trust and the engagement with the patient because we realize it's not really about us having our team, it's about the patient having their team and picking who the right people might be to ensure consistent care when they are in the clinic or in the hospital, but also at the home in the community where they live. Physical delivery mechanisms is the other area that we will be looking at over the next series. Those physical delivery mechanisms include traditional care environments like the hospitals and clinics we were talking about, but also innovative models, increasing use of mobile units, retail clinics, virtual hubs. The goal of this to achieve high quality personalized care wherever they are, but really because we're supporting accessibility, we are improving access to care and convenience and quality of care for all people in the community where they live. We're excited about this area and really delving into it more after this foundational document. Now, the first area we'll talk about is starting to push some of our procedures out of the main hospital or tertiary hospital setting. But I think some of these models like the mobile units and really care at home models are ones that we'll be excited to delve into more. And if you're working on these, we'd love to hear more during our chat. And then an area near and dear to my heart is really thinking about technology today. If we think about the sheer amount of information that's out there about any one patient, when you have 20 minutes to sit with them and take care of them, there is actually no way that the human brain can go out there, source the data, parse through it and figure out everything you need to know about this patient to give them the best care possible. We get really close, but the more we have increasing data out there about people, the less able we are in a short period of time to pull that data. So what do we need? We need technology to work for us. So we need technology to take the data, to give us the right information about the right patient such that when we are interacting with them, whether it's in a clinic, in the hospital setting, or even answering a phone call from home, we have the information that we need. So that data-driven care is really reshaping how we can care for patients. Remote monitoring, we have been ahead of so many other fields in thinking about remote monitoring, but now how do we really optimize that to not be a unit separate from our care, but to be incorporated in our care? And then really think about disease-specific and episode-based protocols. And we'll talk about atrial fibrillation in just a little while with Ginger. And then lastly, I know a lot of people ask me about emerging technologies, and yes, there are quite a few of them, and we consistently work with them to evaluate how do you ensure that the 96% of cardiovascular technologies that are ending up on a shelf actually end up being in care with patients, helping us best understand how to reach people in the communities where they live. And so there's a lot of work to be done there. And again, if that's an area of interest for you, we are looking for more contributors as we move forward from this foundational doc. So let me end with this. You'll start to see from us some self-assessment tools. There's one available for generative AI already if you want to start using generative AI in practice. Self-assessment tools to help you evaluate what is your current care delivery status, where are the areas that you want to make a change, and then what do you need to do to make that happen. Really important to have a strong decision-making structure. So you need to make sure that you have a shared mission and aligned vision of where you want to head, and then really use the tools that we are offering in those focus areas such that they stay aligned with your mission. Really important to have access to robust data. And so it's very important to us that as we're thinking about this, we're making sure to create diverse databases that we can use to ensure that our clinical decisions are grounded in the patients whom we're treating. Multidisciplinary model and shared care we talked about already. And then I'll end by just saying, we recognize that economic alignment is important. And so when we think about how are we balancing clinical excellence with financial responsibility, we do have to be careful to pick things that not only align with mission, but that are things that we can manage to do with what we have. The part that's been missing for a long time, not only in cardiology, but really in thinking about how-to guides in medicine in general has been assessment results. There's been a lot of how to build the best clinic, how to do, for example, in my case, adult congenital heart disease care. And one of the things that we're really trying to push forward through this foundational document and moving forward is assessment results. If you end up using the tools in your practice, it is really helpful for the feedback back to us saying, hey, this worked, this didn't, this is the type of population because that will inform future tools that are created by ourselves and help us prioritize and guide how we're going to improve these frameworks such that they're even more scalable over time. So that's just a very broad introduction to kind of what we're thinking about and where we're headed as we move forward. We wanted to give one deep dive example. So I'm gonna turn it over to Ginger to talk about how to deep dive this. And then we're gonna have more than enough time for questions that you may have on any of our existing tools that we've already put out or ideas for future tools that we should be creating together. Ginger, let me turn it over to you. Thank you so much. I appreciate it. It's truly an honor and pleasure to be part of this initiative as well as to partner with AMI. And so thank you for that. So what I wanted to do, and I'm gonna get request control, is kind of walk you through an example. So, you know, the concept that we put together here is to lay a framework around the how and framing it in a way of how to make it effective. So, and the idea being, let's create a bit of a set of rules or a set of steps or a set of decisions or some sort of a kind of a structure. And AMI mentioned at the beginning kind of that infrastructure, a structure in which we do this care transformation work. And I also wanna add that I think oftentimes we think of transformation as being very daunting and massive change. I think we can take a step back from that. It can mean that, but it can also mean small steps and maybe a better direction for the way we take care of our patients. Maybe a little bit different way we use our people, a better way or a new way we partner around and utilize technology, a shift in the place of service where we're actually performing the care and providing the care for our patients. So you can think of it as a shift. And in some cases we have seismic shifts and in some cases we're making small shifts, but the goal of all of this is to kind of realign the care that we're delivering with the quintuple aim, the outcomes, the experiences of our patients, our staff, as well as the cost effectiveness. So I'm gonna walk you through an example and our document, our foundation document kind of includes a step-by-step approach at the end. So that's what I'm gonna do right now. I'm gonna walk you through a step-by-step approach and give you an example of what this could look like. All right, so the first step is an ideation and decision-making. So ideation kind of just brainstorming around, we have an opportunity, we may have a program, we may have a service that we're offering that doesn't really have a program. We may wanna start a new disease management clinic. We may want to look at an episode of care a little differently and how we better align within that episode for our patients. I mean, there's a number of different sorts of activities that you can use this framework for. But it really starts with engaging the key stakeholders to take an opportunity, challenge, or an idea to develop a solution or a new way to deliver that care that is ultimately achieving the desired outcomes. I'll go back to what Ami said at the very last piece of her section. And that is, I think you have to start with the outcomes you're seeking to achieve and back yourself into that. And if we haven't defined how our vision is going to get us the outcomes that we're looking for, how the vision and the outcomes, how do we know we got there? If we haven't defined it, you're like a rudderless ship. You really don't know where you're going. And again, the work that I do, that means programs that languish. We had a great idea. We got started 6, 12, 24 months later. We're just kind of languishing. It's not really going anywhere. I think part of that is because we didn't identify and figure out how to measure to get, are we getting the effect that we're looking for? And if we're not, what do we need to do to pivot or optimize or change or shift in order to do that? So vision, idea, what we want to go, but how do we know we're successful? Start with that end in mind. You want to assemble the right team. So physician champion, administrator, operational leaders, administrators, your clinic team members, so whoever's going to be part of that team. Always include if this is a revenue, any sort of revenue generating sort of thing. Revenue cycle team, your information technology team, business analyst is really helpful when you start to get into the modeling and the pro forma stage of all of this. But think about who are all the different people and parts that either need to be available to support the program, as well as who is going to be part of delivering into the program. And then you need that vision and that champion to really lead that. And you use this team again, start with the end in mind, what are you seeking to achieve? So many of you may have noted about a month ago, a great document came out from a Heart Rhythm Society looking at an AFib center of excellence. And I don't think they could have done that better. They almost to the T followed this framework and I'm not even sure we probably didn't even have a published yet. So that kind of goes to say, this isn't all brand new and something that Ami and I made up. This is a good, strong, I would call it an implementation science framework and they did such a great job with it. I thought I'm gonna pull kind of their methodology into this and kind of show you how this works. So for this particular example, the goal is to develop an AFib center of excellence. So, and I know you all are managing AFib inside of your programs. So the concept here is who might be those key stakeholders? Well, electrophysiologists, clinical cardiologists, because it's not just our EP doctors that are managing AFib, your advanced practice providers, and you may have some from different areas, you know, hospital, outpatient, your nursing team, your anticoagulation team, if you're running your program that way, a program administrator, revenue cycle, business analyst, patient technology, informaticist, and then who are the other places where these patients present before they ever even make it to cardiology? So primary care, emergency room, hospitalists, so again, start thinking about who are those others. It isn't just cardiology or electrophysiology that's managing these patients, so we need to really kind of think about who all touches these. So bringing together kind of that multidisciplinary and key stakeholders, and what might this look like? Second step is to define the care objective. So if we're going to build an AFib center of excellence, what are the objectives of care that we need to meet? So this kind of gets us back to, we got to say what our end is, then we can look at, figure out how we're going to measure to that, but defining that care objective. So what are you seeking to achieve? What are those patient outcomes? Based on that, you'll start to develop what are my care delivery considerations, kind of the who, the where, the when, the how, what is your evidence base and guidelines tell you? So you can start to pull all of that information based on these patient populations or particular disease processes, what are the things that we should be doing? And then again, social determinants of health and understanding within these patient populations, what are some of those significant pieces that we need to also solve for, at least consider? So in this case, if I go back to, and I went ahead and referenced a document, I would recommend if any of you are doing work in AFib, get your hands on this. Again, they really did a nice job. The care objectives that you have, there's three pillars of AFib management. There's stroke risk. We need to assess the risk and treat it, if identified. All the modifiable risk factors. So those of you who know AFib, there's a number of key risk factors. Think sleep, apnea, think obesity, think hypertension, think there's a whole list. And then symptom management. So part of that is understanding their atrial fibrillation burden. Are we going to rhythm control them versus rate control them? There's medications, pharmacologic opportunities, as well as procedural opportunities. So starting to kind of think in those three pillars or three sets of care objectives that our new center of excellence needs to solve for or include management of. So then we need to identify the target patient population. And we've sort of said, yep, it's going to be atrial fibrillation, but where do those patients present into our system? Where are we going to identify those patients? Where should we look to identify those patients? Where does the care start and stop? Do we wait for them to be referred because somebody else identified? Do we look at this from a population management and we go out into our network and look for where we've got primary, even secondary diagnosis associated and seek out those patients to say are we managing them appropriately? And then what level of accessibility is going to be needed to meet the demand? So what kind of volumes are we expecting? How often are they going to need to be seen? How available do we need to be to get them into our center of excellence program? What does that start to look like? So I provided a few examples for you based on some of the work that we've done, but you've got, we definitely know they present to the emergency department. They present and sometimes even develop AFib during a hospitalization. We see it in our post-surgical, like our post open heart patients. That's a risk that we sometimes see them develop atrial fibrillation. We see them present to primary care and then primary care refers them over to cardiology and then we find them inside of cardiology. So think device clinic where we're monitoring those rhythms. Patient may have a pacemaker, but now they've developed atrial fibrillation. It was identified by the device nurse. Now we need a way to manage them. So start to think about where are all these places that these patients may present and now we need to then take that into account. How do we engage those patients and get them, activate them, if you will, and get them into our program. So now where do we need to be presenting this care and what needs to be rolled in as we start to think about our center of excellence and again, the authors of this paper did a really nice job, but what's the appropriate site of care and sometimes the answer's all of these, but do we need to have support or ability to manage in an acute care setting? I think so. Yes. In a procedural care setting. So in our EP labs and in some, and the answer's yes. Our imaging diagnostics, we're definitely going to be ordering certain imaging protocols for these patients as part of the workup. We may even identify the AFib during a diagnostic study. So we need to control for that there. And then in our ambulatory settings, again, many kind of thinking about your office space and then what is our actual setting of care? Do we have an opportunity for some of these patients from a longitudinal perspective to provide some of this care virtually? So what might that look like, whether in an e-console or in a long-term management where we're doing some telehealth, digital health, or even some remote patient monitoring for these patients. So there's a number of things that you can start to consider as you think about the site of care. And one of the things I really liked the way that the authors of this paper put together, they even developed goals for all of those different settings. So as you think about where these patients are, our goal in an acute care setting might look very different than our goal in an ambulatory setting. So the how and the who, and somehow I knew this was going to happen. This is like the occupational risk of working from home and having dogs. I apologize if you can all hear that. I expect they will settle down here in just a second. So the how and the who of delivering this care. So you want to outline and define all the required care objectives. So again, if you go back, we were talking about stroke assessment and management of risk. We talked about those comorbidities or risk factors that we need to manage, and we talked about AFib symptoms and then AFib actual rhythm versus rate control management. And as we start to define what are all those different areas that we need to take into account and manage, we can start to look at, is this a evaluation and management objective? Is this a diagnostic objective? Is this a long-term management? Do we need some remote patient monitoring, procedural care? And basically what we're doing is we're starting to build a care pathway. So if you think about that initial patient that presents with atrial fibrillation, what happens, what needs to happen on those first few days? What are the questions that need to be asked and answered, the risks that need to be assessed and managed, the diagnostics that need to be pre-performed and interpreted, and then the ultimate plan of care that's going to be developed as that clinical information starts to come through. So when you start to map that out on a longitudinal basis, and I would recommend that, get your key stakeholders together, get a whiteboard and map that out from presentation to effective management, what you're going to find is lots of different objectives in there that begin to appear and you realize they can belong to different people on the team. And it starts to define who is delivering which portions of the care. So then as you put that care pathway together, that's what you then begin to start to operationalize and where you're going to start doing your people, your processes, your IT to kind of bring all of that together. Now we've mentioned it before, I'm going to mention it again because I think this is one I agree with Ami. We don't always do a good job of this, and this is to me imperative for success, but we have to define it. How are we going to say six months from now, 12 months from now, how are we going to gauge whether or not our new program is successful? So what are the patient outcomes we're seeking to achieve and how are we going to measure those? What are the operational metrics we should be looking at and how are we going to measure that and where does the data come from? Are we interested in our cost of care? We might be, we might not be, we might be. If you are, figure out do we have a way of measuring that, how we're going to look at that. And then always, always, always team and staff satisfaction, and I actually would add one more on there, and that's patient satisfaction. How well are we doing from an experiential perspective and does our team have what they need to do their job? So you think about it from a where does the data sit, what does the assessment look like, what should we be measuring, and then how do we bring that all together back to our teams because one of the most important components of a high performing team is improvement. Is that culture, a portion of their culture being focused on how can we improve? So that continuous quality improvement piece, we don't know what to improve if we're not measuring and we're not monitoring and we're not getting the data back in the hands of the people that are delivering the care. So implementation, I kind of jumped ahead a little bit when I said operationalizing, but really developing a pro forma. So this is where you start to put pen to paper. We got our care pathway, we know what are all the pieces and parts that need to be managed and the type of care that we need to be providing. We should have a pretty good idea from our historical input points what our volumes might look like, and we can start to then put together that map that pulls in the economics, both your expenses and your staffing, your facility, some of the other pieces, and again, for most of you that are part of a system, they probably have very specific areas of expenses and overhead and things that you can pull in to apply here, but then also revenue. So if we're providing certain services, certain procedures, certain diagnostics, you can map all that out based on these patients and then apply it to the patient volume that you're anticipating and that's kind of where you start to put together that expense kind of P&L. It's a proposed P&L, which is really a pro forma. And then again, pull it if you have access, there's a good project management to kind of develop a step-by-step plan for your operationalization of the program. I am a big fan of pilots, although I have heard some, a very smart person once said to me, pilots are a bad idea because they give everybody the idea that this is optional. So when it gets hard, we quit because we're like, well, we were just piloting, so we're going to try something. So I go back and forth on whether or not pilots are a good thing, but I would also say the flip side of it is it means it doesn't have to be permanent and it allows us to try things. So I kind of live on both sides of that concept around pilots, but start something. Let's bring in the first 25 patients and run them through this program and see what this looks like. And then what do you need to do to ramp up from there, closely monitoring that first cohort and then you can kind of start to back off as you see the outcomes, the experience, all the books, different things that you're measuring and you begin to achieve. And then finally, and I bulleted this large communicate, communicate, communicate. You can not over-communicate these things. Number one, it allows for good buy-in both within your local team, but within the broader team. Two, new things get people excited. So if you're looking for engagement within your programs and engagement within your staff and your teams, celebrate these things, let them know what's going on. There's a good chance the patients you're seeking might live in some of their spaces. So that's also a great way to engage and make sure we're getting the appropriate patients that deserve these programs. And then communicate after, how are we doing? Be transparent with the data, transparent with the outcomes, tell the stories. All of these pieces are really, really important for not only internal team communication, but external communication out to your colleagues and those that share care with these patients or within these programs. So with that, I'm going to transition it back and ask Ami to join and maybe we can have a little discussion over these next 15, 20 minutes. Fantastic. Well, thank you, Ginger. And I love having concrete examples once we understand kind of what we're going for, because I think sometimes it helps you understand how to put the different parts together. Maybe just a question for you while some of these questions are coming in, which is in your experience and really looking at building the right team, kind of team-based care, where do you see technology as potentially supporting the team? Are there one or two areas where you think, hey, the way things are advancing today, these are the parts of the team that could pretty quickly become more efficient? Yeah. So I was going to ask you the same question as you were going through your piece. So I'll start and I'm interested to see where you sit with all of this too. I think there's a couple things. I think there's one that many, I'm not sure if we're to most yet, but I'm going to say many organizations are dabbling with and specifically in cardiology, probably our primary care partners are farther along the line. And that is the ambient artificial intelligence. And Ami, you wrote some really nice pieces on that, but the ability to use another set of ears and a technology to synthesize an incredible amount of data that we can collect at a face-to-face or a virtual interaction with our patients and consolidate all of that and create something meaningful out of that, that doesn't require someone sitting at the computer typing or somebody dictating into a dragon or an old, old version of the dictation that we've all done. So I think that one is an imperative at this point. There are places that have done it, are doing it well. It's still evolving, but I remember when we started doing template reporting and it's been a full evolution, really, if you think about it over the last 15 years. I think that's number one. We've got to figure out how to use our AI to assist our documentation processes and decrease that administrative burden of capturing those data elements from our clinical teams. The second one, which probably is more challenging, but I actually think it has the ability of an incredible value if we can figure this out. And there are people that are doing that. And that is where we have our repository of all of our clinical data. When I say all, it may very well be related to a specific patient population or group of patients. It may be related to the patient data that's inside of our care network based on the system that we're part of or where we're delivering our care. But the concept is this. We have all this clinical data. We've got diagnostic data. We've got E&M data. We've got all sorts of things that if we can think about laying the chat GPT down on top of that data and asking, querying certain things, either gaps in care or risk factors that would lead to, or just even give me all the patients that I'm currently managing this particular condition and then allow me to then develop my population or disease management program. I now know who I'm building it for. I've got all the data, but historically it's been very challenging to pool the data in a meaningful way that allows our teams to act on it. So I think there's gotta be, and that probably requires, there's places that are doing it well, but I think that's the other piece. And you mentioned that a little bit earlier, Ami, with our ability to use that technology to find those details that allow us to be more effective as physicians and other clinicians on the team and even broader team members. So I think there's both of those things I love and they would have been my answers too. So I guess I'll take it a step further, which is when we think about these voice-to-text technologies, there's a couple of different ways to think about voice AI. So first is exactly what you said, right? The idea of a scribe, if you will, but a smarter version of one who can recognize things, pull things out, put something together and still have oversight by the clinician to say, yes, this is what I meant to say in my note, right? This is correct and now we can send it out. So to ease that burden and allow direct face-to-face communication. The other part of voice AI that's coming up a lot, so I'm just gonna bring it up, is I saw another company just a few days ago, this is now the fourth that I've seen kind of just recently out of maybe 20, who are voice AI agents, right? So AI agents are people who are like chat bots with a voice, sometimes a face, often just the voice, that will interact with you and try and help you get information. So, you know, some of the places are kind of frontline or desk areas, if you're calling to get a service done for something to be answered by somebody at least, who then asks you some questions, right? And you're okay with that being like an auto dealer. One thing. Different if you call your physician's office or nurse's office and now you're asking for questions from your clinical team. But some of the really nice examples have been opportunities to call somebody after discharge and see how they're doing. Have a conversation with them, get some of that information out of them that might be interesting or necessary for us to know, whether as a intro step, like a pre-person you talk to before you talk to the discharge person who's supposed to call you, or whether it's an additional touch point. And I'm really interested in looking at that area for a few reasons. One is the latency. So the awkwardness of, right, computer, that's gone now. Latency is really good. There's a lot of kind of intonation. One of the companies I met with actually started with seven years of research, looking at vocal cords and listening to the sounds of the vocal cords in people who had anxiety or depression. They started in the mental health space and now they've come. And so they're even more able to be able to tell if somebody has pressured speech, how do you respond? If somebody has, and so they're not making a mental health diagnosis, although people are moving towards thinking a lot of things based on speech, right? Heart failure based on speech, different emotional states based on speech. But the interaction, the intonation is even better now in some of these. So you really feel like you're talking to somebody who's listening, to somebody who has patience, to somebody who's not rushed because they're answering your call or asking you about discharge at the same time that like three other people are waiting to be discharged and something else because we oftentimes tax our clinicians with five jobs at once, right? Instead of one at a time. And so I'm really interested to see where that goes and how we can use it, not to replace jobs, but to make sure that we have more touch points that are valuable with our patients. And I think one of the reasons is, and this came up because I saw Vivek Murthy and I trained with him and I saw him in an interview, I think just yesterday or the day before. And in that interview, he was talking about kind of his original time as Surgeon General and his book about loneliness. And when we think about a lot of the reasons that people either come back and end up in a hospital or that they spend a lot of time with their clinicians, there are a lot of people who are lonely out there. And so to be able to have something or someone to interact with, I think it's a really interesting thing for us to try. I do think we need to study its effect on our patients at the same time, because just to say, because you talk to a robot, you're no longer alone. I think that's not what I'm trying to say, but I'm just really intrigued now that we've got this first part and people are really up and running with voice to text, on the way out, is there a role for voice AI agents? I don't know if you've had any experience with that. So very early experiences, which is far from probably what's available now from a latency perspective and even from an ability to tailor responses based on like an algorithm from, we ask a question, this is the response and then we may have an ability to run down an algorithm for more clarifying questions to gather more information. One of the first projects I did after coming to MedAxium almost 11 years ago, so this probably would have been about nine to nine and a half years ago, was a remote patient monitoring app for heart failure patients that used an avatar. And it was a nurse avatar and the avatar could be programmed to be like me, right? To kind of create a little bit of alignment there and that it was very well received. We did some patient satisfaction experience piece and how did they feel about it? It was well received by the cohort, I think we probably had about 200 patients that we put through that program and it was a really a fun transitional care type program, but we use this avatar app as part of that connection. And it asked a set of questions and it was those daily, how are you feeling today? Give me a red, green, yellow and how did you sleep? And are you feeling short of breath? But it asked some kind of clarifying to allow it to grab some objective type data that then all got collected and went back to the clinical care team on the other side. And if the patient answered any of the questions in like the negative way, it was a very specific, give me this answer and here's your three choices. And if you hit this choice, then the clinical team was notified as kind of, it's no different than kind of pushing the buttons with the texts that come, but it was well received. And I've also, as you have done some work on this to understand the experience part, and you look at the literature most, and I would say even me from a personal perspective, most of us don't mind avatar or a robot or a chat bot if we know that's what it is. It's when we try to bait and switch and we make our end user think that it's really a human when it's not, that we feel a little, maybe a lot disappointed and frustrated and maybe a little bit taken advantage of. But if we know what it is, we all use them when you call the airlines, when you call any number of places that you call, that's what you're, we all use them. And when they're reliable, they capture the data that needs to be captured, the end user experience, the ease of use is there, the accessibility, majority of people will be like, that would be perfectly fine. I just, just be upfront with me of what this really is. Absolutely, and you know, so much of healthcare too, when we talk about healthcare delivery, a lot of it is logistics. You know, a lot of it is science and application of clinical medicine, but a lot of the rest that needs to get done is logistics. You know, hey, I just learned that my insurance company doesn't cover this anymore, or which insurances, I need a different set or I need a different thing, right? Whatever it might be, can you offer me something different? That's a pretty algorithmic answer. You know, let me register that, let me look at this, this is the thing we'd need, we will let the team know. And so I think even for some of those conversations, you may not even want, I mean, there are times where you probably don't want the clinician to be the one answering that question because the likelihood that, you know, I have memorized the formulary for this week, it changes a lot, right? So I think some of those places that are the more logistic kind of mundane parts, but that need to happen for you to get your healthcare, maybe those are some of the first places that we can, you know, on the other end, try that. The part you talked about with data, this question comes up a lot, which is, the data in the EHR may not be enough to tell me everything I know. And that is why I ask a lot of questions, but I run short of time to ask all of the questions. And so, you know, I'm a big patient reported outcomes fan. And so I think the arrows are fantastic. And I also, you know, we did some research showing that PROs help engage patients even more in their own care, right? Because not only in general, but even in the moment, doing a patient reported outcome measure test helps you focus better and slow down and become one of those slow thinking, right? Like type two learners. Ada Stephanescu did a study and it was fantastic. And so just thinking about that and engaging and getting more patient information, I guess, where do you see as we start doing more team-based care, where do you see that influx of really patient generated information coming in, both in preparation for a visit, or even kind of chronically, where are you doing it in the practices of MedAxiom or in your history? And where do you think is the most promise of like, hey, we really need to focus more on getting data from this person in this phase to these people. Any thoughts on that? Yeah, so I think a couple of things. One is I think it's, I'm seeing for those that are developing strong clinical programs around particular patient populations, building that in as part of the assessment. So as an example, we did a big initiative related to cardiometabolic. Well, cardiometabolic, there's a number of pathologic disease processes that sit behind that. But there's also a number of psychosocial access to food, psychological health, mental health, so depression, anxiety. And when we sat down with a number of different programs and we did some demonstration sites, worked with some key physician leaders around development of their program, a key piece of this was on the front end as part of the intake process, a series of survey type data collection from the patient. And some of those were developed through a, let's give the patient a iPad and let them run through the questions. We've all done that. Some of those were, it's more of, but some of them it felt better to sit down and actually had an interaction with the patient between say the patient, some of them were a medical assistant, some would have been the pharmacist, some would have been a nutritionist or a dietician. So kind of based on, so I think there were two things with that. One, identifying what are the risks that we need to, of comorbidities, of current lifestyle, of current habits, of kind of where the patient is from a mental health perspective, as well as even from an understanding of some of these disease processes, we need to do a baseline. And so we needed to figure out what is the baseline we need to capture and what are the validated survey tools that are available in order to do that. So then let's put that together. And then we had to figure out how to operationalize it. So again, sometimes it was send the patient a link and here's a couple of survey tools in there we need you to take. And other times the decision was let's, this does better with a face-to-face interaction. So let's, but it's this person's job, this person's job. And the other cool part about that was probably about 60% of those different tools turned into longer term assessment to get your outcomes because we would repeat those at six months or 12 months. So not only were we getting our clinical data back, checking our labs, our hemoglobin A1C, some of our lipid panels, some of those sorts of data elements, but we were rerunning the risk tools so we could see if we made an improvement, even like a rate your plate, understanding eating habits. So I think it's incredibly important and it's sometimes a bit of a lift to figure out and get all the data and then figure out where that data is housed and figure out who's gonna manage it. No, no, absolutely. So it's interesting, I am here in Boston, we have a large venture capital community and I've been talking to some of them about, different companies and things that might be in cryology. And what I noticed is all of them are wearing something, there's some sort of a wearable, there's a snack here, there's a watch there. So many of us are wearing something. And I just specifically pick on that population for a moment because one of the things that came up is we recently released our Apple Watch guide for clinicians and patients right on how to engage and create an infrastructure for Apple Watch data. So you're just not throwing information at yourself as a client of Apple Watch or to your clinicians. And I got a lot of questions about, can we do this for other wearables? And the answer is, absolutely. It's actually a very similar process, sometimes a little different based on what the technology is, what's FDA approved, what you should use, what shouldn't. And so we're excited to do this work. But as I started doing it, I thought a little bit about patient reported outcomes. And wouldn't it be interesting, because the number of times I look at any apps I use, or even ones that, let's just admit, I use Noom very intermittently, that didn't go great for me. But as you're, not that it's not a good app, I'm just saying my tendency to use it rapidly. But if you're looking at apps that we use on our phone, whether you have a Comm, or a Noom app, or a Flow, or your wearables, they're oftentimes where they're asking you, how are you feeling today? And you're putting data in. Most people are entering something about how they're doing consistently, or maybe even inconsistently, but over a long period. If between the times I see my patient, there were a way to even get that data, right? The qualitative data about how people are feeling from their wearables. I would love to see, I'm calling on John Spertus, my good friend who taught me about PROs, or other people who are really good at it. Can we pull that together? Can we actually create patient-reported outcomes that are real, that have some metrics, out of some of the things that they're already doing in their daily life? Because then you're not asking someone in the half hour before a clinic visit, or the day before, how do you feel about all these things? It's a lot of questions to answer. And it kind of depends on the day you're having. But if you consistently, over a few months, look at this, you'll probably come up with a, hey, it seems like this is the trend that I'm seeing. And so, I just think there's so much promise that we have moving forward, to think about how technology and our patients can be more involved in care delivery, as you and I, and our audience, and the team, kind of build the rest of these tools to help us really transform care delivery. Absolutely. Couldn't agree more. This will be fun. Well, I think we're just about at time. So, please do take a look at the foundation document. I think maybe we can send through the chat the kind of link to it again, but would be excited to have people give us ideas on what future topics within what we talked about, you actually do wanna see. If you have examples of quality programs, or metrics you're using, or new technology, it would be really great to hear from you. If not on webinars like this, please feel free to reach out on LinkedIn or Twitter and find us. LinkedIn might be the best place for me. Ginger, for you? It'd be the same. Yeah, LinkedIn for both of us. Please reach out, let us know what you're interested in, and let us know how you like the products we do create. Yeah, thank you. Thank you for everyone attending today.

Care Transformation Initiative

community-based care

cardiovascular care

social determinants of health

team-based care

innovative care delivery

technology in healthcare

patient-reported outcomes

AI in healthcare