1 00:00:00,160 --> 00:00:02,159 Hello, everyone, and welcome to the Becker's Healthcare 2 00:00:02,159 --> 00:00:04,879 Podcast. I'm Scott King. Thrilled today to be 3 00:00:04,879 --> 00:00:07,919 joined by doctor Ryan Rivera, medical director and 4 00:00:07,919 --> 00:00:09,699 clinical assistant professor 5 00:00:10,080 --> 00:00:12,559 over at Stanford Health Care. Doctor Rivera, how 6 00:00:12,559 --> 00:00:14,695 are you doing today? I'm doing alright. Thanks 7 00:00:14,695 --> 00:00:16,695 for having me. Of course. Thanks so much 8 00:00:16,695 --> 00:00:18,135 for joining us. We have a lot of 9 00:00:18,135 --> 00:00:20,375 big topics and and trends in health care 10 00:00:20,375 --> 00:00:21,574 to get to. But before we get to 11 00:00:21,574 --> 00:00:22,934 the questions, I was wondering if you could 12 00:00:22,934 --> 00:00:24,535 please tell us a little bit about your 13 00:00:24,535 --> 00:00:25,035 background. 14 00:00:26,219 --> 00:00:28,779 Sure. Yeah. Yeah. So, you know, as you 15 00:00:28,779 --> 00:00:31,259 stated, I'm an emergency medicine doc. I'm the 16 00:00:31,259 --> 00:00:33,579 medical director of the adult emergency department over 17 00:00:33,579 --> 00:00:35,659 here at Stanford. But I think maybe worth 18 00:00:35,659 --> 00:00:37,820 noting that I've, my whole career, I've kind 19 00:00:37,820 --> 00:00:40,059 of straddled a a few different spaces. So, 20 00:00:41,675 --> 00:00:43,755 you know, came up as a resident at 21 00:00:43,755 --> 00:00:47,195 Stanford, did administrative fellowship here, and obviously continued 22 00:00:47,195 --> 00:00:50,075 on in, traditional health care operations. Got a 23 00:00:50,075 --> 00:00:52,954 master's in public health focused on administration as 24 00:00:52,954 --> 00:00:53,454 well. 25 00:00:54,109 --> 00:00:56,230 But also have spent a lot of time 26 00:00:56,230 --> 00:00:57,870 in the tech industry. I I used to 27 00:00:57,870 --> 00:01:00,590 be a program manager over at Google. I've 28 00:01:00,590 --> 00:01:01,969 been part of a number of, 29 00:01:02,590 --> 00:01:05,010 health tech start up companies along the way. 30 00:01:05,150 --> 00:01:05,869 And then, 31 00:01:06,349 --> 00:01:09,390 currently, I'm also the medical director for digital 32 00:01:09,390 --> 00:01:11,844 health for acute care here at Stanford Health 33 00:01:11,844 --> 00:01:13,604 Care and also run kind of our industry 34 00:01:13,604 --> 00:01:15,224 partnership program as well. 35 00:01:15,844 --> 00:01:17,685 So we've kind of viewed things through both 36 00:01:17,685 --> 00:01:20,104 lenses. How can we use traditional operations 37 00:01:20,405 --> 00:01:22,724 to expedite throughput and improve care? And then 38 00:01:22,724 --> 00:01:25,509 also how can we leverage technology, especially in 39 00:01:25,509 --> 00:01:27,769 the current environment to do those things better. 40 00:01:28,869 --> 00:01:30,790 When you see how emerging tech has kinda 41 00:01:30,790 --> 00:01:32,549 taken health care by storm, are you really 42 00:01:32,549 --> 00:01:34,390 glad that you you spent some time in 43 00:01:34,390 --> 00:01:35,909 that space before you got to where you 44 00:01:35,909 --> 00:01:36,569 are now? 45 00:01:37,245 --> 00:01:38,685 Yeah. Absolutely. I mean, every 46 00:01:39,405 --> 00:01:40,944 one of the things I like about technology 47 00:01:41,004 --> 00:01:41,504 is, 48 00:01:42,045 --> 00:01:44,284 it's it always seems like you're just right 49 00:01:44,284 --> 00:01:45,885 there on the bleeding edge of some really 50 00:01:45,885 --> 00:01:47,405 cool stuff. And so, you know, right now, 51 00:01:47,405 --> 00:01:48,465 it's it's AI, 52 00:01:48,765 --> 00:01:50,765 obviously, but, you know, previous to that, it 53 00:01:50,765 --> 00:01:53,209 was telemedicine. And, you know, previous to that, 54 00:01:53,209 --> 00:01:55,390 it was clinical informatics. And so, 55 00:01:55,849 --> 00:01:56,349 they 56 00:01:56,729 --> 00:01:58,250 I think it was exciting then, but it's 57 00:01:58,250 --> 00:01:59,549 even more exciting now. 58 00:02:00,329 --> 00:02:02,090 Yeah. A 100%. We're always we're always waiting 59 00:02:02,090 --> 00:02:03,849 for that new that new shiny object. It's 60 00:02:03,849 --> 00:02:05,209 always about to come, and and we do 61 00:02:05,209 --> 00:02:06,489 get it. And then there's another one. 62 00:02:07,689 --> 00:02:08,145 What 63 00:02:08,544 --> 00:02:10,705 opportunities and headwinds do you have your eye 64 00:02:10,705 --> 00:02:12,324 on right now in health care? 65 00:02:13,264 --> 00:02:15,605 Yeah. You know, I mean, I think definitely 66 00:02:16,224 --> 00:02:18,465 the the you know, from my position in 67 00:02:18,465 --> 00:02:20,724 the emergency department, one of the biggest headwinds 68 00:02:20,784 --> 00:02:23,419 is this kind of national crisis we're having 69 00:02:23,419 --> 00:02:24,800 around boarding and capacity. 70 00:02:25,500 --> 00:02:27,419 We experienced it at Stanford, but we're not 71 00:02:27,419 --> 00:02:30,000 the only ones. I mean, emergency departments that 72 00:02:30,300 --> 00:02:31,840 are half filled, sometimes 73 00:02:32,139 --> 00:02:33,675 three quarters filled with, 74 00:02:34,074 --> 00:02:35,055 you know, overflow 75 00:02:35,514 --> 00:02:36,495 boarding patients, 76 00:02:37,034 --> 00:02:39,135 who are, you know, admitted at the hospital. 77 00:02:39,594 --> 00:02:40,495 And, you know, the 78 00:02:41,034 --> 00:02:44,074 the associated problem of just inpatient hospitals not 79 00:02:44,074 --> 00:02:45,215 having enough space, 80 00:02:45,835 --> 00:02:48,074 you know, either either because they lack the 81 00:02:48,074 --> 00:02:48,735 the physical 82 00:02:49,180 --> 00:02:51,180 plant to do it or because they don't 83 00:02:51,180 --> 00:02:53,599 have sufficient staffing to utilize their beds. 84 00:02:54,540 --> 00:02:56,219 You know, I I think the other thing 85 00:02:56,219 --> 00:02:57,900 that we're grappling with at Stanford, and I 86 00:02:57,900 --> 00:02:59,260 know we're not the only ones, is, you 87 00:02:59,260 --> 00:03:00,480 know, the acuity, 88 00:03:01,465 --> 00:03:03,085 that we see is rising. 89 00:03:03,705 --> 00:03:06,104 Some of that is due probably to an 90 00:03:06,104 --> 00:03:07,004 aging population. 91 00:03:07,784 --> 00:03:09,385 Some of it is, you know, a little 92 00:03:09,385 --> 00:03:11,385 bit of a mystery. It'd be interesting to 93 00:03:11,385 --> 00:03:13,544 see, you know, from a population health perspective 94 00:03:13,544 --> 00:03:15,145 when we look back on this era post 95 00:03:15,145 --> 00:03:17,539 COVID and study it, you know, why acuity 96 00:03:17,539 --> 00:03:19,379 seems to be rising in EDs across the 97 00:03:19,379 --> 00:03:21,459 country. But it it it's definitely true for 98 00:03:21,459 --> 00:03:22,900 us, and I know it's true for others. 99 00:03:22,900 --> 00:03:24,500 So how do you deal with that? More 100 00:03:24,500 --> 00:03:25,719 people coming in the door, 101 00:03:26,259 --> 00:03:28,840 those people are sicker than they've ever been, 102 00:03:29,074 --> 00:03:30,995 and you have to manage that with fewer 103 00:03:30,995 --> 00:03:33,354 beds than you've, you know, than you're used 104 00:03:33,354 --> 00:03:35,014 to having to care for that population. 105 00:03:36,034 --> 00:03:37,875 Yeah. And and you mentioned, you know, kinda 106 00:03:37,875 --> 00:03:39,014 needing more staff 107 00:03:39,474 --> 00:03:41,014 influx of patients. 108 00:03:41,314 --> 00:03:43,655 So, you know, a lot of times that's 109 00:03:43,794 --> 00:03:46,270 acquired through growth, obviously. So how are you 110 00:03:46,270 --> 00:03:48,830 thinking about growth and adding value to your 111 00:03:48,830 --> 00:03:49,569 your organization? 112 00:03:50,430 --> 00:03:52,430 Yeah. It's interesting. You know, in the emergency 113 00:03:52,430 --> 00:03:53,969 department, we're one of the only, 114 00:03:54,669 --> 00:03:57,389 you know, clinical groups that really doesn't wanna 115 00:03:57,389 --> 00:03:59,150 grow too much. I think I think we 116 00:03:59,150 --> 00:04:01,294 would prefer if there were fewer patients coming 117 00:04:01,294 --> 00:04:03,055 in the door or at least if the 118 00:04:03,055 --> 00:04:04,355 patient's coming in the door, 119 00:04:04,735 --> 00:04:06,594 you know, we're, we're ones who, 120 00:04:06,895 --> 00:04:09,055 you know, truly needed our care. You know? 121 00:04:09,055 --> 00:04:10,974 Unfortunately, obviously, all of the growth that we 122 00:04:10,974 --> 00:04:13,770 experience is due to other downstream challenges in 123 00:04:13,770 --> 00:04:15,449 our health care system and and patients not 124 00:04:15,449 --> 00:04:17,050 being able to access the right care in 125 00:04:17,050 --> 00:04:18,430 the right place at the right time. 126 00:04:18,730 --> 00:04:20,430 And so, you know, for us, it's 127 00:04:20,810 --> 00:04:22,649 it's less about how do we get more 128 00:04:22,649 --> 00:04:24,649 patients in the door. But, you know, given 129 00:04:24,649 --> 00:04:26,250 that there are more patients coming in the 130 00:04:26,250 --> 00:04:29,185 door, how do we grow our functional capacity 131 00:04:29,485 --> 00:04:30,464 to care for them? 132 00:04:30,925 --> 00:04:33,004 Because, again, without without being able to usually 133 00:04:33,004 --> 00:04:34,384 grow our physical spaces, 134 00:04:34,845 --> 00:04:37,084 it's it's about how can you see more 135 00:04:37,084 --> 00:04:39,805 people with the same resources. And so a 136 00:04:39,805 --> 00:04:41,105 lot of times that is, 137 00:04:41,529 --> 00:04:42,990 you know, just traditional 138 00:04:43,449 --> 00:04:45,790 operational efficiency. You know, how do you triage 139 00:04:46,889 --> 00:04:50,050 more efficiently? How do you, move patients through 140 00:04:50,050 --> 00:04:52,410 the the standard phases of care, get their 141 00:04:52,410 --> 00:04:55,375 labs quicker, their imaging quicker, their consultations quicker 142 00:04:55,375 --> 00:04:57,294 so that they can get dispositioned and you 143 00:04:57,294 --> 00:04:59,235 can make more space for the next patient. 144 00:05:00,014 --> 00:05:02,834 Sometimes it is, you know, utilizing technology 145 00:05:03,134 --> 00:05:03,794 to develop, 146 00:05:04,254 --> 00:05:06,675 you know, novel treatment pathways. At Stanford, 147 00:05:07,389 --> 00:05:09,629 we have a virtual visit track. So patients 148 00:05:09,629 --> 00:05:10,930 who show up to our ED, 149 00:05:11,470 --> 00:05:12,529 if they meet criteria, 150 00:05:12,830 --> 00:05:15,889 can get, funneled over to a, 151 00:05:16,670 --> 00:05:17,410 a telemedicine 152 00:05:17,710 --> 00:05:19,564 track where they sit in front of a 153 00:05:19,564 --> 00:05:22,365 computer, and they're seen virtually by a remote 154 00:05:22,365 --> 00:05:24,285 emergency physician who can still give them all 155 00:05:24,285 --> 00:05:25,644 the care that they need, and and those 156 00:05:25,644 --> 00:05:27,324 patients get through a lot more quickly and 157 00:05:27,324 --> 00:05:27,985 get home. 158 00:05:28,444 --> 00:05:30,044 And then it's also, you know, how can 159 00:05:30,044 --> 00:05:31,024 we think about 160 00:05:31,910 --> 00:05:34,149 it's because because the walls of our ED 161 00:05:34,149 --> 00:05:35,910 aren't gonna change. How do we expand the 162 00:05:35,910 --> 00:05:38,550 care we provide beyond the walls of the 163 00:05:38,550 --> 00:05:39,770 ED? How do we, 164 00:05:40,709 --> 00:05:43,449 you know, intervene when a patient is considering 165 00:05:43,910 --> 00:05:44,889 emergency care 166 00:05:45,435 --> 00:05:47,754 and, you know, either either make sure that 167 00:05:47,754 --> 00:05:49,194 they come in to get it or make 168 00:05:49,194 --> 00:05:50,555 sure that if if they don't need to 169 00:05:50,555 --> 00:05:52,154 come in, that they're still getting the care 170 00:05:52,154 --> 00:05:53,675 that they need outside of that. So, for 171 00:05:53,675 --> 00:05:56,314 example, you know, again, at Stanford, we have 172 00:05:56,314 --> 00:05:57,835 set up a program where we've got a 173 00:05:57,835 --> 00:06:00,415 telemedicine card at a local skilled nursing facility. 174 00:06:00,839 --> 00:06:02,920 And, you know, when they're contemplating bringing appreciation 175 00:06:02,920 --> 00:06:04,439 into the ED, they instead put them in 176 00:06:04,439 --> 00:06:05,639 front of the cart. And one of our 177 00:06:05,639 --> 00:06:08,120 EM docs is able to to very often 178 00:06:08,120 --> 00:06:10,379 care for them there on the spot preventing 179 00:06:10,520 --> 00:06:12,600 an ED arrival. And so those are kind 180 00:06:12,600 --> 00:06:13,800 of some of the ways that we're thinking 181 00:06:13,800 --> 00:06:14,860 about how do we, 182 00:06:15,264 --> 00:06:17,264 given that our volume are is expanding, how 183 00:06:17,264 --> 00:06:19,425 do we expand our ability to provide care 184 00:06:19,425 --> 00:06:21,904 for this larger patient population with the same 185 00:06:21,904 --> 00:06:22,404 resources? 186 00:06:23,985 --> 00:06:25,824 Do you think the virtual visit track has 187 00:06:25,824 --> 00:06:27,584 already made a big difference in terms of 188 00:06:27,584 --> 00:06:28,084 efficiency? 189 00:06:29,149 --> 00:06:30,269 Oh, yeah. I mean, so, 190 00:06:32,110 --> 00:06:34,370 and you kinda had to think of efficiency 191 00:06:34,430 --> 00:06:36,750 a little bit differently, actually, when you're talking 192 00:06:36,750 --> 00:06:38,930 about things like the virtual visit track. So, 193 00:06:39,069 --> 00:06:42,105 you know, is is that doc churning through 194 00:06:42,105 --> 00:06:44,264 as many patients per hour as they are 195 00:06:44,264 --> 00:06:46,264 in some of our other zones? Frankly, no, 196 00:06:46,264 --> 00:06:47,404 if you look at the statistics. 197 00:06:47,944 --> 00:06:48,444 However, 198 00:06:48,904 --> 00:06:50,904 you know, when you got somebody who is 199 00:06:50,904 --> 00:06:51,964 seeing sometimes 200 00:06:52,745 --> 00:06:54,925 22, 23, 24 201 00:06:55,229 --> 00:06:57,389 patients a day, and they're doing it just 202 00:06:57,389 --> 00:06:59,889 with a cart. No ED room necessary. 203 00:07:00,269 --> 00:07:02,930 That's huge. I mean, that is 10%, 204 00:07:03,389 --> 00:07:04,689 of our daily arrivals, 205 00:07:05,069 --> 00:07:07,694 and we don't even need a bed. 206 00:07:08,074 --> 00:07:09,035 And so it's, 207 00:07:10,714 --> 00:07:13,355 definitely resource efficient when you're talking to the 208 00:07:13,435 --> 00:07:16,175 when the resource is the geography. It's tremendously 209 00:07:16,394 --> 00:07:18,875 efficient on that front. And then it's also 210 00:07:18,875 --> 00:07:20,714 very efficient when the when the resource you're 211 00:07:20,714 --> 00:07:23,009 talking about is that patient's time. They get 212 00:07:23,009 --> 00:07:23,990 through much faster, 213 00:07:25,089 --> 00:07:27,410 and they they don't crowd up our our 214 00:07:27,410 --> 00:07:29,410 ED waiting room quite so much. And then, 215 00:07:29,410 --> 00:07:31,569 you know, actually, it's turned out that, 216 00:07:32,770 --> 00:07:34,930 it's very popular from a patient perspective as 217 00:07:34,930 --> 00:07:35,670 well. It's 218 00:07:36,574 --> 00:07:38,254 surprising to us, but it continues to be 219 00:07:38,254 --> 00:07:40,334 our most popular zone in the ED right 220 00:07:40,334 --> 00:07:41,235 now. And so, 221 00:07:41,774 --> 00:07:44,514 you know, it's it's when it's safe care, 222 00:07:44,574 --> 00:07:46,814 the patients like it, and it's very efficient. 223 00:07:46,814 --> 00:07:48,834 I mean, it's it's turned out to really 224 00:07:49,029 --> 00:07:50,089 hit on all fronts. 225 00:07:50,550 --> 00:07:52,970 Sounds like it's popular for good reason there. 226 00:07:53,990 --> 00:07:56,229 Let me ask you, what is one risk 227 00:07:56,229 --> 00:07:58,149 or investment do you think is worth making 228 00:07:58,149 --> 00:07:58,810 this year? 229 00:08:01,029 --> 00:08:03,050 Yeah. I mean so I I think there's 230 00:08:03,514 --> 00:08:04,014 there's 231 00:08:04,714 --> 00:08:05,694 probably a few 232 00:08:06,394 --> 00:08:08,314 a few things to think through here, but 233 00:08:08,314 --> 00:08:09,375 I I would say 234 00:08:09,915 --> 00:08:12,254 this year going into '26, 235 00:08:12,475 --> 00:08:13,134 I think 236 00:08:13,595 --> 00:08:16,555 it's a very important time for EDs to 237 00:08:16,555 --> 00:08:20,029 start integrating things like predictive analytics into their 238 00:08:20,029 --> 00:08:20,529 workflows. 239 00:08:21,709 --> 00:08:23,550 This is a kind of thing that I 240 00:08:23,550 --> 00:08:26,430 think three, four years from now even will 241 00:08:26,430 --> 00:08:26,930 be 242 00:08:27,389 --> 00:08:30,269 absolutely standard, and emergency departments that have a 243 00:08:30,269 --> 00:08:31,949 bit of a jump start on how to 244 00:08:31,949 --> 00:08:34,475 utilize them are going to be, 245 00:08:34,855 --> 00:08:37,735 you know, ready for the continued increase in 246 00:08:37,735 --> 00:08:39,754 in patients coming through our doors. 247 00:08:40,375 --> 00:08:41,914 So, you know, we're we're 248 00:08:42,455 --> 00:08:44,375 planning to implement in the coming year, for 249 00:08:44,375 --> 00:08:46,794 example, predictive analytics at the point of triage 250 00:08:46,855 --> 00:08:47,674 to help us 251 00:08:48,450 --> 00:08:50,769 determine whether a patient is appropriate for things 252 00:08:50,769 --> 00:08:53,090 like our virtual visit track or our vertical 253 00:08:53,090 --> 00:08:55,649 work streams, or can they just be discharged 254 00:08:55,649 --> 00:08:57,250 from the waiting room, or do they we 255 00:08:57,250 --> 00:08:58,210 need to send them to one of our 256 00:08:58,210 --> 00:08:59,649 high acuity areas so that we can make 257 00:08:59,649 --> 00:09:00,550 sure we're utilizing, 258 00:09:01,004 --> 00:09:03,404 you know, our care spaces most appropriately. We're 259 00:09:03,404 --> 00:09:07,164 looking at utilizing it, upstream at the hospital 260 00:09:07,164 --> 00:09:09,644 capacity level so we can better predict ED 261 00:09:09,644 --> 00:09:12,384 inflows, surgical inflows, transfer center inflows. 262 00:09:13,245 --> 00:09:14,304 And, therefore, 263 00:09:15,440 --> 00:09:17,679 you know, kind of pre pull levers some 264 00:09:17,679 --> 00:09:20,160 of our interventions when we anticipate we are 265 00:09:20,160 --> 00:09:22,559 going to have heavy capacity days rather than 266 00:09:22,559 --> 00:09:24,559 being quite so reactive. And I think by 267 00:09:24,559 --> 00:09:26,820 doing that, we'll harvest a lot of efficiency. 268 00:09:27,554 --> 00:09:28,835 And then, you know, there's a lot of 269 00:09:28,835 --> 00:09:31,394 other opportunities here. I think from, like, a 270 00:09:31,394 --> 00:09:31,975 a needy 271 00:09:32,674 --> 00:09:34,294 operations and management standpoint 272 00:09:35,075 --> 00:09:35,575 using, 273 00:09:37,235 --> 00:09:39,794 AI for charting, I think, for us, we 274 00:09:39,875 --> 00:09:42,819 we've been doing this already, has produced more 275 00:09:42,819 --> 00:09:45,459 thorough charting that is more amenable to being 276 00:09:45,459 --> 00:09:48,579 coded appropriately so you can get paid appropriately 277 00:09:48,579 --> 00:09:50,259 for the work that you do. And then, 278 00:09:50,259 --> 00:09:52,019 you know, I I think once you've got 279 00:09:52,019 --> 00:09:54,919 AI that's got access to some of the, 280 00:09:55,325 --> 00:09:57,924 you know, ED notes and also the structured 281 00:09:57,924 --> 00:09:59,684 data in the chart, there's a lot of 282 00:09:59,684 --> 00:10:00,664 additional opportunities, 283 00:10:02,004 --> 00:10:03,065 I think, as well. 284 00:10:03,605 --> 00:10:05,784 A lot of additional opportunities as well, 285 00:10:06,404 --> 00:10:09,009 for us to start predicting things like, you 286 00:10:09,009 --> 00:10:11,829 know, which patients might benefit from early palliative 287 00:10:11,889 --> 00:10:14,450 care intervention, which patients are likely to need 288 00:10:14,450 --> 00:10:16,769 ICU care, and therefore we can, you know, 289 00:10:16,769 --> 00:10:18,690 move them up there more quickly and also, 290 00:10:18,690 --> 00:10:21,009 you know, convey that information to the, you 291 00:10:21,009 --> 00:10:22,309 know, the hospital 292 00:10:22,769 --> 00:10:23,909 capacity leads. 293 00:10:24,485 --> 00:10:27,044 Or, you know, even which patients are likely 294 00:10:27,044 --> 00:10:29,365 to have a bad experience where while they're 295 00:10:29,365 --> 00:10:31,625 there. So we can utilize kind of our 296 00:10:31,764 --> 00:10:32,264 our, 297 00:10:33,125 --> 00:10:35,924 our resources well to, you know, help smooth 298 00:10:35,924 --> 00:10:37,829 some of that over and, you know, make 299 00:10:37,829 --> 00:10:39,509 sure that all of our patients are getting 300 00:10:39,509 --> 00:10:41,509 the care that they need with, you know, 301 00:10:41,509 --> 00:10:43,669 in in the manner that that meets their 302 00:10:43,669 --> 00:10:45,909 needs. So I think there's a a lot 303 00:10:45,909 --> 00:10:46,970 a lot of opportunities 304 00:10:47,429 --> 00:10:47,829 that, 305 00:10:48,709 --> 00:10:51,049 it's worth dipping our toes into, 306 00:10:51,589 --> 00:10:53,664 if not jumping in with both feet in 307 00:10:53,664 --> 00:10:54,404 '26. 308 00:10:55,424 --> 00:10:57,985 Because I think these trends of increasing volumes, 309 00:10:57,985 --> 00:11:01,205 increasing acuity are not really going to stop. 310 00:11:01,345 --> 00:11:03,345 And so these are the types of tools 311 00:11:03,345 --> 00:11:06,049 we gotta get facility with quickly so that 312 00:11:06,049 --> 00:11:09,009 we can not be overwhelmed in '27 or 313 00:11:09,009 --> 00:11:09,750 '28. 314 00:11:10,850 --> 00:11:12,049 And the last question I have for you, 315 00:11:12,049 --> 00:11:14,210 doctor Rivera, where do you see the best 316 00:11:14,210 --> 00:11:14,710 opportunities 317 00:11:15,169 --> 00:11:16,470 for growth in the future? 318 00:11:18,285 --> 00:11:18,785 So 319 00:11:19,565 --> 00:11:21,325 I think I think we've talked about one, 320 00:11:21,325 --> 00:11:21,985 which is 321 00:11:22,365 --> 00:11:23,424 predictive analytics, 322 00:11:23,725 --> 00:11:24,865 AI enabled, 323 00:11:25,725 --> 00:11:28,125 care and operations within the walls of the 324 00:11:28,125 --> 00:11:28,625 ED. 325 00:11:29,004 --> 00:11:30,990 You know, I I do think another area 326 00:11:31,070 --> 00:11:33,389 again, growth is interesting concept in the emergency 327 00:11:33,389 --> 00:11:34,830 department. So another interesting 328 00:11:35,590 --> 00:11:37,790 another way that we can think about how 329 00:11:37,790 --> 00:11:40,129 to extend our capabilities 330 00:11:41,389 --> 00:11:45,070 is through this idea of expanding emergency medicine 331 00:11:45,070 --> 00:11:46,495 beyond the walls of the ED. And we 332 00:11:46,495 --> 00:11:47,934 talked about a a few of those ways 333 00:11:47,934 --> 00:11:49,134 that that can be done, I think, through 334 00:11:49,134 --> 00:11:49,634 telemedicine, 335 00:11:50,014 --> 00:11:52,654 you know, telesniff programs, tele EMS programs, which 336 00:11:52,654 --> 00:11:53,554 are very analogous. 337 00:11:54,014 --> 00:11:55,315 On the other end of the spectrum, 338 00:11:56,014 --> 00:11:58,334 hospital at home programs, and that's something also 339 00:11:58,334 --> 00:12:00,459 that we're looking at at Stanford is, you 340 00:12:00,459 --> 00:12:02,299 know, discharging people from the hospital a little 341 00:12:02,299 --> 00:12:04,559 bit earlier than we otherwise would. 342 00:12:05,179 --> 00:12:06,700 But we do that because we have a 343 00:12:06,700 --> 00:12:08,779 remote provider who can check-in on them and 344 00:12:08,779 --> 00:12:10,620 get them the last, you know, vestiges of 345 00:12:10,620 --> 00:12:12,459 what they would have gotten inpatient. And we're 346 00:12:12,459 --> 00:12:14,139 looking at doing that from the ED as 347 00:12:14,139 --> 00:12:15,934 well so that we can take patients we 348 00:12:15,934 --> 00:12:18,014 might have admitted to a physical, you know, 349 00:12:18,014 --> 00:12:20,495 clinical decision unit or an ops unit and 350 00:12:20,495 --> 00:12:22,034 instead do ops at home. 351 00:12:22,414 --> 00:12:25,154 I think those those are some big opportunities, 352 00:12:25,855 --> 00:12:27,855 that and we have the technology to do 353 00:12:27,855 --> 00:12:29,879 now. It's just about the workflows. And then 354 00:12:29,879 --> 00:12:32,000 on the other end, you know, the spectrum, 355 00:12:32,000 --> 00:12:32,660 I think 356 00:12:33,279 --> 00:12:36,580 there's in addition to things like telesniff and, 357 00:12:36,960 --> 00:12:38,179 tele EMS control, 358 00:12:40,080 --> 00:12:42,259 there are, I think, a lot more opportunities 359 00:12:42,320 --> 00:12:44,660 through digital health and telemedicine to provide patients 360 00:12:44,879 --> 00:12:47,615 with tools and education in real time as 361 00:12:47,615 --> 00:12:49,394 they're contemplating ED care, 362 00:12:49,855 --> 00:12:50,595 that can, 363 00:12:50,975 --> 00:12:52,355 you know, prevent visits, 364 00:12:52,654 --> 00:12:53,475 that are unnecessary 365 00:12:54,095 --> 00:12:56,034 and get patients a little bit better targeted. 366 00:12:56,095 --> 00:12:57,534 So I I think, there 367 00:12:58,095 --> 00:12:59,154 I know at Stanford, 368 00:12:59,480 --> 00:13:00,460 a lot of our outpatient 369 00:13:01,080 --> 00:13:03,559 clinics have now converted to telemedicine, and many 370 00:13:03,559 --> 00:13:05,639 of those in conjunction with, like, remote patient 371 00:13:05,639 --> 00:13:06,620 monitoring tools, 372 00:13:07,399 --> 00:13:09,980 are able to identify patients who, 373 00:13:10,600 --> 00:13:11,100 are, 374 00:13:11,634 --> 00:13:14,115 you know, having chronic issues with their chronic 375 00:13:14,115 --> 00:13:14,615 diseases 376 00:13:14,995 --> 00:13:17,554 escalating or, you know, other concerns that might 377 00:13:17,554 --> 00:13:19,954 eventually lead to an emergency presentation, and they're 378 00:13:19,954 --> 00:13:21,334 able to intervene remotely, 379 00:13:22,115 --> 00:13:23,954 before that happens. And so I think those 380 00:13:23,954 --> 00:13:24,034 are 381 00:13:25,000 --> 00:13:26,700 again, it's not about expanding 382 00:13:27,160 --> 00:13:28,759 space. Of course, if your an ED has 383 00:13:28,759 --> 00:13:31,160 the opportunity to expand your your care spaces, 384 00:13:31,160 --> 00:13:33,000 you should probably take it. You're probably gonna 385 00:13:33,000 --> 00:13:34,759 need it. But most of us don't have 386 00:13:34,759 --> 00:13:36,059 that, and so it is, 387 00:13:36,519 --> 00:13:39,394 extending our ability to care for patients into 388 00:13:39,394 --> 00:13:42,455 the pre and post ED visit space, 389 00:13:42,995 --> 00:13:44,434 to make sure that they're getting the right 390 00:13:44,434 --> 00:13:45,715 care in the right place at the right 391 00:13:45,715 --> 00:13:48,835 time and making sure that the precious ED 392 00:13:48,835 --> 00:13:51,075 space that we have is utilized for those 393 00:13:51,075 --> 00:13:52,054 who need it most. 394 00:13:53,759 --> 00:13:55,519 Doctor Roberta, thanks so much for joining us 395 00:13:55,519 --> 00:13:57,300 on the podcast. It was a great conversation. 396 00:13:57,360 --> 00:13:58,559 I look forward to working with you again 397 00:13:58,559 --> 00:14:00,899 soon. Yeah. Thanks so much for having me.