1 00:00:00,160 --> 00:00:02,399 This is Laura Dierda with the Becker's Healthcare 2 00:00:02,399 --> 00:00:04,480 podcast. I'm thrilled today to be joined by 3 00:00:04,480 --> 00:00:07,040 doctor FJ Campbell, chief medical officer at Ardent 4 00:00:07,040 --> 00:00:08,480 Health. Doctor Campbell, it's a pleasure to have 5 00:00:08,480 --> 00:00:10,740 you on the podcast today. Thank you, Laura. 6 00:00:11,039 --> 00:00:12,719 Now I'm excited for our conversation. I know 7 00:00:12,719 --> 00:00:15,244 we're gonna be digging deeper into AI technology 8 00:00:15,384 --> 00:00:17,484 and some of the real real world benefits, 9 00:00:17,864 --> 00:00:19,384 that you can get into and and digging 10 00:00:19,384 --> 00:00:21,404 deep into those practical solutions 11 00:00:21,704 --> 00:00:23,864 that AI can today truly, truly solve in 12 00:00:23,864 --> 00:00:25,785 the health care space. But before we dive 13 00:00:25,785 --> 00:00:27,625 in, can you just briefly introduce yourself and 14 00:00:27,625 --> 00:00:29,064 tell us a little bit more about Ardent 15 00:00:29,064 --> 00:00:29,564 Health? 16 00:00:30,480 --> 00:00:32,260 Sure. I'm an emergency physician. 17 00:00:32,880 --> 00:00:34,960 I've been with Ardent for about eight years 18 00:00:34,960 --> 00:00:35,460 now. 19 00:00:35,920 --> 00:00:39,619 The company, 30 hospitals across several markets. 20 00:00:40,320 --> 00:00:43,219 We really focus on forming partnerships with academic 21 00:00:43,359 --> 00:00:43,859 centers, 22 00:00:45,085 --> 00:00:48,685 for improving community assets. We very clearly have 23 00:00:48,685 --> 00:00:51,164 achieved success with that model. It's novel. It's 24 00:00:51,164 --> 00:00:52,145 also effective. 25 00:00:53,164 --> 00:00:55,245 Our hospitals really are cross section, which you're 26 00:00:55,245 --> 00:00:56,844 gonna find in The United States, which means 27 00:00:56,844 --> 00:00:58,365 we also have a cross sections of the 28 00:00:58,365 --> 00:01:00,829 problems you encounter in delivery of health care 29 00:01:00,829 --> 00:01:01,810 in The United States. 30 00:01:02,750 --> 00:01:04,989 Notions of virtual care and AI are are 31 00:01:04,989 --> 00:01:07,329 very attractive now, and they're very exciting. 32 00:01:07,870 --> 00:01:09,730 And they and they pull out the futuristic 33 00:01:10,270 --> 00:01:12,855 interests of so many people. But in our 34 00:01:12,855 --> 00:01:15,734 world, with our practical problems, we need practical 35 00:01:15,734 --> 00:01:18,715 solutions. So I look forward today to communicating 36 00:01:18,935 --> 00:01:19,435 how 37 00:01:19,814 --> 00:01:23,594 virtual care and AI specifically are bringing true, 38 00:01:24,135 --> 00:01:27,594 measurable, both clinical, operational, and financial benefits, 39 00:01:28,349 --> 00:01:30,030 so that more people can engage in this 40 00:01:30,030 --> 00:01:32,829 work. Because, candidly, I need more people engaging 41 00:01:32,829 --> 00:01:34,270 in this work. We need a community of 42 00:01:34,270 --> 00:01:36,209 learners on this, and we don't have 43 00:01:36,750 --> 00:01:39,390 enough facilities engaging in this. So that's very 44 00:01:39,390 --> 00:01:40,750 much why I wanted to speak to you 45 00:01:40,750 --> 00:01:41,250 today. 46 00:01:42,045 --> 00:01:43,325 I love that. And I think this is 47 00:01:43,325 --> 00:01:45,884 a conversation that certainly has a ripple impact 48 00:01:45,884 --> 00:01:47,805 on so many hospitals and health systems and 49 00:01:47,805 --> 00:01:50,685 organizations that listen to our podcast regularly because 50 00:01:50,685 --> 00:01:52,304 you're right. I mean, looking at the technology 51 00:01:52,364 --> 00:01:53,664 of virtual care AI, 52 00:01:54,290 --> 00:01:56,850 being rooted into solutions and spaces where you 53 00:01:56,850 --> 00:01:57,990 can truly find, 54 00:01:58,370 --> 00:02:01,250 the biggest benefit, is the transformational aspect of 55 00:02:01,250 --> 00:02:03,810 it. Now I know Ardent Health announced plans 56 00:02:03,810 --> 00:02:06,450 to launch enterprise wide virtual physician, nurse, and 57 00:02:06,450 --> 00:02:08,805 patient observation platform. You talk a little bit 58 00:02:08,805 --> 00:02:10,645 more about that initiative and how it will 59 00:02:10,645 --> 00:02:11,784 transform care delivery? 60 00:02:12,645 --> 00:02:14,105 It's it started out of COVID, 61 00:02:14,485 --> 00:02:16,645 like, so many things. Now there were some 62 00:02:16,645 --> 00:02:18,245 positives that came out of COVID, and what 63 00:02:18,245 --> 00:02:19,844 we realized is what we could do in 64 00:02:19,844 --> 00:02:21,944 terms of lever leveraging 65 00:02:22,564 --> 00:02:23,784 a telehealth visit, 66 00:02:25,419 --> 00:02:28,479 for meeting our staffing needs and our 67 00:02:29,020 --> 00:02:30,479 and our patient access needs. 68 00:02:31,099 --> 00:02:33,099 But we were really also concentrating on the 69 00:02:33,099 --> 00:02:35,520 realization that our nursing staff had just become, 70 00:02:37,034 --> 00:02:38,254 completely burned out. 71 00:02:39,034 --> 00:02:41,834 There was an untenable amount of volume of 72 00:02:41,834 --> 00:02:42,735 work for nursing, 73 00:02:43,194 --> 00:02:44,014 staff to do, 74 00:02:44,394 --> 00:02:45,775 nursing leaders to manage, 75 00:02:46,555 --> 00:02:48,955 a higher level of acuity than we'd ever 76 00:02:48,955 --> 00:02:49,694 seen before, 77 00:02:50,379 --> 00:02:52,219 and we had gotten into a cost curve 78 00:02:52,219 --> 00:02:53,360 that had become unsustainable. 79 00:02:54,699 --> 00:02:55,599 And with that, 80 00:02:56,219 --> 00:02:58,780 the challenge that our board put in front 81 00:02:58,780 --> 00:02:59,840 of us very 82 00:03:00,219 --> 00:03:00,719 proactively 83 00:03:01,500 --> 00:03:04,080 was we have to find a system for 84 00:03:04,620 --> 00:03:05,439 load balancing 85 00:03:06,435 --> 00:03:06,935 nursing 86 00:03:07,395 --> 00:03:09,795 care, and very quickly, we arrived upon virtual 87 00:03:09,795 --> 00:03:10,295 nurses. 88 00:03:10,835 --> 00:03:13,254 So what our virtual nurses actually do, 89 00:03:14,435 --> 00:03:16,694 we believe at Arden on the notion of 90 00:03:16,835 --> 00:03:19,795 technology should be made by end users for 91 00:03:19,795 --> 00:03:20,534 end users, 92 00:03:21,110 --> 00:03:22,870 and that the real customer there is the 93 00:03:22,870 --> 00:03:23,610 end user. 94 00:03:24,310 --> 00:03:26,629 So we went to nursing leaders across the 95 00:03:26,629 --> 00:03:29,289 enterprise and said, what do you want to 96 00:03:29,430 --> 00:03:31,110 take off of your checklist? What do you 97 00:03:31,110 --> 00:03:32,810 wanna take off of your to do list? 98 00:03:33,110 --> 00:03:35,610 And the and the areas that quickly surfaced 99 00:03:35,669 --> 00:03:36,169 were 100 00:03:36,754 --> 00:03:39,555 we can't do admissions well, intakes well in 101 00:03:39,555 --> 00:03:41,415 patients frequently because we're interrupted. 102 00:03:42,194 --> 00:03:44,915 We can't do discharges well frequently because we're 103 00:03:44,915 --> 00:03:45,415 interrupted. 104 00:03:46,354 --> 00:03:47,974 And when it comes to, 105 00:03:48,514 --> 00:03:50,534 maintaining, you know, purposeful rounding, 106 00:03:51,500 --> 00:03:53,659 we can't necessarily maintain the schedule that we 107 00:03:53,659 --> 00:03:54,560 would want to. 108 00:03:54,939 --> 00:03:57,439 So it was those three areas that we, 109 00:03:57,900 --> 00:04:01,020 effectively executed on. And what we found what 110 00:04:01,020 --> 00:04:02,219 I found when I would go to the 111 00:04:02,219 --> 00:04:04,460 markets with the units where we basically launch, 112 00:04:04,460 --> 00:04:07,105 where we'd have, you know, virtual nurses, we 113 00:04:07,105 --> 00:04:09,504 would have RNs, we'd have PCTs, sometimes we'd 114 00:04:09,504 --> 00:04:11,585 have LPNs or LPNs depending on where you 115 00:04:11,585 --> 00:04:12,085 are. 116 00:04:13,745 --> 00:04:15,344 Nurses would come up to me, grab me 117 00:04:15,344 --> 00:04:17,024 on the arm, and be like and pull 118 00:04:17,024 --> 00:04:18,944 me over. You're like, you actually brought me 119 00:04:18,944 --> 00:04:20,245 technology that helped 120 00:04:20,779 --> 00:04:22,779 as if it was a novel concept, which 121 00:04:22,779 --> 00:04:25,420 for so many clinicians, it is. Okay? And 122 00:04:25,420 --> 00:04:27,040 they would show me their to do list. 123 00:04:27,420 --> 00:04:29,279 Like, you see all these boxes here? 124 00:04:30,460 --> 00:04:33,259 The ones that have red check marks through 125 00:04:33,259 --> 00:04:35,355 it, the virtual nurse took care for me. 126 00:04:35,595 --> 00:04:37,194 And the ones that have the black check 127 00:04:37,194 --> 00:04:38,975 marks, I took care of for me. 128 00:04:39,275 --> 00:04:42,395 This has literally allowed me to concentrate more 129 00:04:42,395 --> 00:04:43,295 on my work 130 00:04:43,995 --> 00:04:47,134 and identify where we have potential safety gaps, 131 00:04:47,675 --> 00:04:49,295 where we have throughput gaps, 132 00:04:50,120 --> 00:04:51,800 where I can actually connect with a patient 133 00:04:51,800 --> 00:04:53,399 in a way that I haven't done before 134 00:04:53,399 --> 00:04:54,860 because I can actually, like, 135 00:04:55,639 --> 00:04:56,620 not be frantic. 136 00:04:58,120 --> 00:05:00,520 So turnover on those units went down, but 137 00:05:00,520 --> 00:05:02,779 here's the really, like, hard dollar impact. 138 00:05:03,160 --> 00:05:03,660 Okay? 139 00:05:04,199 --> 00:05:05,660 So on our note units 140 00:05:06,095 --> 00:05:07,475 that have virtual nurses, 141 00:05:08,335 --> 00:05:10,514 if you look at the cost of, like, 142 00:05:10,574 --> 00:05:12,035 nursing care, which includes 143 00:05:12,495 --> 00:05:14,754 contract labor, premium pay, 144 00:05:15,455 --> 00:05:18,035 our our regular FTE nurses, and PCTs, 145 00:05:18,655 --> 00:05:19,475 four areas, 146 00:05:20,379 --> 00:05:23,500 Those are nursing expense. Nursing expense per patient 147 00:05:23,500 --> 00:05:24,160 per day 148 00:05:24,779 --> 00:05:28,800 has gone down consistently between $15 and $30 149 00:05:28,860 --> 00:05:30,160 per patient per day. 150 00:05:31,019 --> 00:05:32,620 This is more than covering what I have 151 00:05:32,620 --> 00:05:33,839 to do on virtual nursing. 152 00:05:35,314 --> 00:05:35,814 Now 153 00:05:36,194 --> 00:05:37,875 let's move on to virtual sitting for a 154 00:05:37,875 --> 00:05:39,955 moment and which actually we refer to in 155 00:05:39,955 --> 00:05:41,334 our organization as 156 00:05:41,634 --> 00:05:42,935 patient safety attendance. 157 00:05:43,955 --> 00:05:47,039 Now the ROI for that, has been proven 158 00:05:47,039 --> 00:05:49,120 by a number of organizations. One of the 159 00:05:49,120 --> 00:05:51,839 first to really achieve success improving that ROI 160 00:05:51,839 --> 00:05:52,579 was Avisure. 161 00:05:53,120 --> 00:05:53,620 Okay? 162 00:05:54,079 --> 00:05:55,680 I mean, they they wrote the book on 163 00:05:55,680 --> 00:05:56,180 that. 164 00:05:56,719 --> 00:05:59,060 And what you can find here is 165 00:06:00,319 --> 00:06:01,139 when you're using 166 00:06:02,014 --> 00:06:03,634 virtual patient safety, 167 00:06:04,495 --> 00:06:04,995 attendance, 168 00:06:05,615 --> 00:06:07,395 first of all, the AI algorithms 169 00:06:07,855 --> 00:06:10,355 have become much more effective at seeing precursor 170 00:06:10,415 --> 00:06:12,975 activities for a patient that can predict who's 171 00:06:12,975 --> 00:06:13,875 going to fall, 172 00:06:15,120 --> 00:06:17,920 which means you can have one patient safety 173 00:06:17,920 --> 00:06:18,420 attendant 174 00:06:18,879 --> 00:06:19,939 virtually monitoring 175 00:06:20,319 --> 00:06:21,220 several patients. 176 00:06:22,879 --> 00:06:23,379 So 177 00:06:23,759 --> 00:06:25,439 what we're doing is we're taking people who 178 00:06:25,439 --> 00:06:28,019 have been strictly patient safety attendants, and sometimes 179 00:06:28,240 --> 00:06:30,295 that sitter could have been a nurse because 180 00:06:30,295 --> 00:06:31,514 that's all we had, 181 00:06:32,855 --> 00:06:33,754 or a PCT. 182 00:06:34,375 --> 00:06:36,295 So we're now having our sitters if you're 183 00:06:36,295 --> 00:06:37,975 gonna be a sitter, you're either gonna be 184 00:06:37,975 --> 00:06:40,055 someone who is a PCT or you're working 185 00:06:40,055 --> 00:06:41,895 in transport or some other capacity in the 186 00:06:41,895 --> 00:06:43,514 hospital, but you're not a nurse 187 00:06:44,569 --> 00:06:47,610 at $39 an hour or a contract labor. 188 00:06:47,610 --> 00:06:49,069 Good god. Okay? 189 00:06:49,689 --> 00:06:51,069 So to that end, 190 00:06:52,970 --> 00:06:54,029 we have a system 191 00:06:54,729 --> 00:06:56,750 that is allowing us to do sustainably 192 00:06:57,129 --> 00:06:59,610 more effective identification of patients at risk for 193 00:06:59,610 --> 00:07:00,110 falling 194 00:07:01,235 --> 00:07:02,615 and at a cost structure 195 00:07:03,394 --> 00:07:05,654 that actually is gonna create a situation where 196 00:07:05,954 --> 00:07:08,214 when we look at what's going to drive 197 00:07:08,675 --> 00:07:09,735 covering our costs 198 00:07:10,595 --> 00:07:12,754 for all of our virtual care platform across 199 00:07:12,754 --> 00:07:13,574 all of our enterprise, 200 00:07:14,290 --> 00:07:17,170 our breakeven point is going to come well 201 00:07:17,170 --> 00:07:20,930 within our contract from virtual sitting savings alone. 202 00:07:20,930 --> 00:07:22,370 And, no, I cannot give you those exact 203 00:07:22,370 --> 00:07:25,110 figures because I can't, and I I won't. 204 00:07:25,170 --> 00:07:25,670 Okay? 205 00:07:26,224 --> 00:07:27,664 But I can tell you that is what 206 00:07:27,664 --> 00:07:29,604 you can count on. Okay? 207 00:07:31,185 --> 00:07:33,925 Certainly with organizations like Abba Share or HelloCare, 208 00:07:34,144 --> 00:07:35,604 that's what you can count on. 209 00:07:36,784 --> 00:07:37,764 I have no disclosures. 210 00:07:38,064 --> 00:07:38,564 Alright? 211 00:07:38,944 --> 00:07:40,644 So with that in mind, 212 00:07:43,020 --> 00:07:45,740 you have a cost sustainable model for sitting 213 00:07:45,740 --> 00:07:48,220 that actually creates a cost sustainable model for 214 00:07:48,220 --> 00:07:50,860 both nursing physician and attending from the savings 215 00:07:50,860 --> 00:07:52,860 of that. But you're also gonna be looking 216 00:07:52,860 --> 00:07:55,839 forward to about a 20% reduction in falls. 217 00:07:56,775 --> 00:07:57,275 Remember, 218 00:07:58,215 --> 00:08:00,215 for what we all have to do in 219 00:08:00,215 --> 00:08:02,134 any kind of health care system, if you 220 00:08:02,134 --> 00:08:03,275 wanna have a sustainable 221 00:08:03,975 --> 00:08:06,855 transformation of care, you need a sustainable economic 222 00:08:06,855 --> 00:08:07,355 model 223 00:08:08,215 --> 00:08:11,275 and a clearly measurable clinical impact. 224 00:08:13,170 --> 00:08:15,250 So let's move on to virtual physician for 225 00:08:15,250 --> 00:08:15,830 a second. 226 00:08:16,449 --> 00:08:18,150 When I think of late to stay, 227 00:08:19,009 --> 00:08:21,430 and I'm in a smaller community hospital, 228 00:08:21,889 --> 00:08:22,389 okay, 229 00:08:23,650 --> 00:08:25,910 it is a really challenging circumstance 230 00:08:26,210 --> 00:08:27,430 to have a whole host 231 00:08:28,014 --> 00:08:30,014 of capabilities. When I think of them, I 232 00:08:30,014 --> 00:08:32,115 think of capability and I think of capacity. 233 00:08:32,894 --> 00:08:34,975 Capacity, do I have beds? Capability, do I 234 00:08:34,975 --> 00:08:36,434 actually have the clinical resources? 235 00:08:37,695 --> 00:08:38,674 Community hospitals, 236 00:08:39,789 --> 00:08:41,389 as long as they can staff and have, 237 00:08:41,389 --> 00:08:41,970 you know, 238 00:08:42,509 --> 00:08:44,929 a capacity to break even even, 239 00:08:45,870 --> 00:08:46,610 they will 240 00:08:47,470 --> 00:08:48,769 bring more patients in. 241 00:08:49,149 --> 00:08:51,230 The challenge they're going to have is, will 242 00:08:51,230 --> 00:08:54,370 they have the clinicians and specifically the specialists 243 00:08:55,355 --> 00:08:56,894 to execute on that care? 244 00:08:57,274 --> 00:08:59,355 If I have a hospital that's a smaller 245 00:08:59,355 --> 00:09:02,014 facility in a more distant community, 246 00:09:02,315 --> 00:09:04,954 and ultimately I have a cardiologist only available 247 00:09:04,954 --> 00:09:06,095 three days a week, 248 00:09:06,794 --> 00:09:08,634 my length of stay is going to go 249 00:09:08,634 --> 00:09:09,134 up. 250 00:09:10,200 --> 00:09:13,240 And my ability to retain higher acuity patients 251 00:09:13,240 --> 00:09:14,779 is going to go down. 252 00:09:15,959 --> 00:09:16,459 And 253 00:09:16,839 --> 00:09:19,399 EMS will, in time, know that and go 254 00:09:19,399 --> 00:09:20,620 past my hospital. 255 00:09:21,815 --> 00:09:23,754 But if I'm in a situation where 256 00:09:24,134 --> 00:09:26,875 I have virtual care capabilities per room, 257 00:09:27,495 --> 00:09:30,475 which then allows me to have virtual sitting, 258 00:09:30,695 --> 00:09:33,254 and that's gonna drive your sustainable return on 259 00:09:33,254 --> 00:09:33,754 investment, 260 00:09:35,190 --> 00:09:37,929 virtual nursing, which is going to supplement that, 261 00:09:38,870 --> 00:09:40,870 the the real and at that point, now 262 00:09:40,870 --> 00:09:42,570 I can afford to have all these systems. 263 00:09:42,870 --> 00:09:44,409 The real benefit becomes 264 00:09:44,870 --> 00:09:48,009 I can now retain higher acuity patients 265 00:09:48,514 --> 00:09:50,754 because through a virtual physician, I have that 266 00:09:50,754 --> 00:09:51,254 cardiologist 267 00:09:51,634 --> 00:09:54,215 seven days a week. I have that nephrologist. 268 00:09:54,355 --> 00:09:56,674 I have that neurologist. I have that infectious 269 00:09:56,674 --> 00:09:57,975 disease tending or pulmonologist. 270 00:09:59,875 --> 00:10:02,059 Now people often come to me like, what 271 00:10:02,059 --> 00:10:04,539 if the COVID waivers on virtual care go 272 00:10:04,539 --> 00:10:06,860 away? Well, that would be a tsunami event 273 00:10:06,860 --> 00:10:08,860 that would be very detrimental to the entire 274 00:10:08,860 --> 00:10:10,779 health care delivery system in The United States, 275 00:10:10,779 --> 00:10:13,279 so I'm not betting on that one. Okay? 276 00:10:13,740 --> 00:10:15,120 But with that in mind, 277 00:10:15,965 --> 00:10:18,125 what you're gonna find, especially as we're looking 278 00:10:18,125 --> 00:10:19,185 at rural facilities, 279 00:10:20,605 --> 00:10:22,285 and you think of the funding that's going 280 00:10:22,285 --> 00:10:24,045 out in terms of the rural health funds, 281 00:10:24,045 --> 00:10:25,725 that's $50,000,000,000 282 00:10:25,725 --> 00:10:26,705 over five years. 283 00:10:28,679 --> 00:10:31,000 If you wanna make sure you're protecting a 284 00:10:31,000 --> 00:10:31,899 rural community, 285 00:10:33,559 --> 00:10:35,659 you want that hospital to stay open. 286 00:10:36,039 --> 00:10:37,179 In rural communities, 287 00:10:38,200 --> 00:10:40,600 a hospital, even a 50 bed hospital might 288 00:10:40,600 --> 00:10:41,500 be the only 289 00:10:42,105 --> 00:10:44,924 destination for a hospital for two hours, 290 00:10:45,304 --> 00:10:47,404 and a lot of The United States experiences 291 00:10:47,465 --> 00:10:47,965 that. 292 00:10:49,144 --> 00:10:51,465 So under the circumstances, if you wanna protect 293 00:10:51,465 --> 00:10:52,284 rural communities 294 00:10:52,585 --> 00:10:54,264 for the love of God, you better protect 295 00:10:54,264 --> 00:10:55,004 those hospitals, 296 00:10:55,440 --> 00:10:57,440 which means you have to get the specialist 297 00:10:57,440 --> 00:10:58,179 to them. 298 00:10:58,480 --> 00:11:00,399 And the only way to defeat time and 299 00:11:00,399 --> 00:11:00,899 geography, 300 00:11:02,080 --> 00:11:02,580 distance, 301 00:11:03,040 --> 00:11:04,419 is through virtual care. 302 00:11:05,279 --> 00:11:07,120 Because what's gonna happen is you're going to 303 00:11:07,120 --> 00:11:10,100 actually be bringing specialty care to those regions. 304 00:11:11,475 --> 00:11:13,174 So when people ask me about, 305 00:11:13,715 --> 00:11:15,394 hey. How is this going to improve patient 306 00:11:15,394 --> 00:11:16,674 safety? I'm like, do you have any other 307 00:11:16,674 --> 00:11:17,654 solutions to that? 308 00:11:18,434 --> 00:11:20,274 If you wanna really make sure that we 309 00:11:20,274 --> 00:11:22,674 have an unsafe environment, let's make sure that 310 00:11:22,674 --> 00:11:24,615 specialists can't get out to these communities. 311 00:11:25,340 --> 00:11:26,700 So when people ask me, like, how is 312 00:11:26,700 --> 00:11:28,940 virtual care, right, actually going to a like, 313 00:11:28,940 --> 00:11:30,379 how are you gonna make sure it improve 314 00:11:30,379 --> 00:11:32,860 and maintains patient safety? I'm like, like, in 315 00:11:32,860 --> 00:11:34,399 comparison to what we have now? 316 00:11:35,580 --> 00:11:36,480 Are you joking? 317 00:11:37,675 --> 00:11:39,455 What we have now is not safe. 318 00:11:40,394 --> 00:11:41,995 That's such a great point. And, you know, 319 00:11:41,995 --> 00:11:45,035 definitely having that opportunity to bring in more 320 00:11:45,035 --> 00:11:45,995 virtual care and, 321 00:11:46,715 --> 00:11:50,075 expanding that capacity for nurses and physicians to 322 00:11:50,075 --> 00:11:51,754 do more within the walls of the hospital 323 00:11:51,754 --> 00:11:54,050 as well as on the outside, and connect 324 00:11:54,050 --> 00:11:55,490 with patients. I know it was a huge, 325 00:11:55,490 --> 00:11:55,990 huge, 326 00:11:57,009 --> 00:11:59,009 win for the health system overall. And I'm 327 00:11:59,009 --> 00:12:01,429 curious, you know, when you look at, incorporating 328 00:12:01,490 --> 00:12:03,410 all of this into the daily workflows of 329 00:12:03,410 --> 00:12:05,750 the clinicians, physicians, patients, etcetera, 330 00:12:07,065 --> 00:12:08,745 what were some of the the challenges that 331 00:12:08,745 --> 00:12:10,904 you ran up against? Because I know, you 332 00:12:10,904 --> 00:12:12,264 know, it it's easy to say, hey. This 333 00:12:12,264 --> 00:12:13,945 is gonna be helpful for you, but to 334 00:12:13,945 --> 00:12:16,105 actually then get adoption and make sure you've 335 00:12:16,105 --> 00:12:18,424 got the right, systems in place in in 336 00:12:18,424 --> 00:12:21,500 the right, people leading these efforts, is critical. 337 00:12:21,500 --> 00:12:22,700 So I'd love to hear a little bit 338 00:12:22,700 --> 00:12:24,300 more about how you've been working through some 339 00:12:24,300 --> 00:12:26,300 of those things and what you were really 340 00:12:26,300 --> 00:12:28,059 able to accomplish with the right plan in 341 00:12:28,059 --> 00:12:29,980 place and and leaders that were leading the 342 00:12:29,980 --> 00:12:30,480 charge. 343 00:12:31,514 --> 00:12:32,495 It was easy. 344 00:12:33,595 --> 00:12:35,514 Let's start off with the patients. Here's what 345 00:12:35,514 --> 00:12:38,394 the patients say. Wow. Someone actually was able 346 00:12:38,394 --> 00:12:40,254 to talk to me for a full conversation. 347 00:12:41,595 --> 00:12:42,975 I mean, that happened, like, 348 00:12:43,850 --> 00:12:44,669 on day 349 00:12:45,610 --> 00:12:46,429 point six. 350 00:12:48,409 --> 00:12:51,070 The patients immediately gravitated to it. 351 00:12:51,769 --> 00:12:52,669 All ages, 352 00:12:53,129 --> 00:12:53,950 all backgrounds, 353 00:12:54,809 --> 00:12:58,044 you name it. The first thing, they immediately 354 00:12:58,044 --> 00:13:00,204 understood what was going on. And the first 355 00:13:00,204 --> 00:13:02,204 thing it would say is, I really appreciate 356 00:13:02,204 --> 00:13:03,485 the fact that I could, like, talk to 357 00:13:03,485 --> 00:13:04,544 you this whole time. 358 00:13:04,924 --> 00:13:06,764 Like, it seems like you're really paying attention 359 00:13:06,764 --> 00:13:08,605 to me. That's the gist of what we 360 00:13:08,605 --> 00:13:10,605 got. I mean, that happened right out of 361 00:13:10,605 --> 00:13:11,264 the gate. 362 00:13:11,980 --> 00:13:13,680 I mean, intentional design 363 00:13:14,139 --> 00:13:17,100 really helped. Like, we didn't have people who 364 00:13:17,100 --> 00:13:19,740 thought, wow. Virtual care. It's really cool. Here's 365 00:13:19,740 --> 00:13:21,740 what I think we should do, and basically 366 00:13:21,740 --> 00:13:22,639 push it down. 367 00:13:23,180 --> 00:13:23,840 It was, 368 00:13:24,584 --> 00:13:26,664 okay. Let's talk to people who are actually 369 00:13:26,664 --> 00:13:28,745 gonna be doing this and actually gonna be 370 00:13:28,745 --> 00:13:31,164 using this. What do they want? 371 00:13:32,504 --> 00:13:35,004 Nurses, by definition, are incredibly 372 00:13:35,384 --> 00:13:36,605 pragmatic individuals. 373 00:13:37,549 --> 00:13:39,309 They've got a list of things they have 374 00:13:39,309 --> 00:13:40,669 to do, they have to get done, and 375 00:13:40,669 --> 00:13:42,610 they will MacGyver their way to it. 376 00:13:42,990 --> 00:13:45,230 And they always do. And they're like, we're 377 00:13:45,230 --> 00:13:47,149 gonna take care of this. We're gonna have 378 00:13:47,149 --> 00:13:47,970 good intakes 379 00:13:48,509 --> 00:13:50,955 to have a better history, a better understanding 380 00:13:50,955 --> 00:13:52,875 of the medications you're on, a better understanding 381 00:13:52,875 --> 00:13:54,254 of the concerns they have, 382 00:13:54,634 --> 00:13:56,634 which gives a better understanding of what the 383 00:13:56,634 --> 00:13:59,195 vulnerabilities are. And when we get to the 384 00:13:59,195 --> 00:14:01,375 end, we're gonna have a better discharge 385 00:14:01,835 --> 00:14:04,540 because so often and even HCAHPS looks at 386 00:14:04,540 --> 00:14:06,480 this. Like, how will the patient appreciate 387 00:14:07,100 --> 00:14:09,259 along the way what their care plan was? 388 00:14:09,259 --> 00:14:10,540 Well, they can talk it out with a 389 00:14:10,540 --> 00:14:11,519 virtual nurse 390 00:14:12,620 --> 00:14:15,500 during their stay. And equally important, do you 391 00:14:15,500 --> 00:14:17,259 understand what you have to do when you 392 00:14:17,259 --> 00:14:17,759 leave? 393 00:14:18,855 --> 00:14:21,815 These are well measured elements, and they are 394 00:14:21,815 --> 00:14:23,735 the specific areas in each caps where our 395 00:14:23,735 --> 00:14:26,235 units that have these tools are rising. 396 00:14:26,855 --> 00:14:28,394 And that means, like, the thinkable. 397 00:14:28,774 --> 00:14:31,115 Like, it's logical. It's believable 398 00:14:31,870 --> 00:14:34,769 It's actually taking place because we're dedicating resources 399 00:14:34,830 --> 00:14:35,570 to it. 400 00:14:36,350 --> 00:14:38,129 So from a nursing perspective, 401 00:14:38,830 --> 00:14:39,809 out of the gate, 402 00:14:40,110 --> 00:14:42,750 win. Like, I'll go to units and nurses 403 00:14:42,750 --> 00:14:44,269 will be like, I know. I'm like, hey. 404 00:14:44,269 --> 00:14:46,370 A a number of our hospitals, we have 405 00:14:46,704 --> 00:14:49,605 a competing hospital, like, literally across the street. 406 00:14:50,784 --> 00:14:52,485 Like, you can hit it with a baseball 407 00:14:52,544 --> 00:14:55,684 without even trying. Okay? So here's the deal. 408 00:14:56,384 --> 00:14:58,225 I'll say, like, what do you think of 409 00:14:58,225 --> 00:15:00,544 this? Like, how how if we took this 410 00:15:00,544 --> 00:15:02,559 away, what would you do? And after they 411 00:15:02,559 --> 00:15:04,080 tell me about how they would flip out, 412 00:15:04,080 --> 00:15:06,960 they're like, I'll give you an example. I'm 413 00:15:06,960 --> 00:15:08,740 getting offers right now from 414 00:15:09,679 --> 00:15:11,759 hospital x, which is across the street, for 415 00:15:11,759 --> 00:15:13,759 3 more dollars an hour. I'm not taking 416 00:15:13,759 --> 00:15:14,259 that. 417 00:15:14,995 --> 00:15:16,274 Now I'm not gonna tell you the game 418 00:15:16,274 --> 00:15:17,794 of what we played in terms of how 419 00:15:17,794 --> 00:15:19,014 much would you take, 420 00:15:19,394 --> 00:15:21,235 but most people are like, here's why I 421 00:15:21,235 --> 00:15:21,975 want this. 422 00:15:22,834 --> 00:15:24,995 And it always gets back to something very 423 00:15:24,995 --> 00:15:25,495 tangible 424 00:15:25,875 --> 00:15:27,634 only in the eyes of the end user. 425 00:15:27,634 --> 00:15:28,294 They're like, 426 00:15:28,600 --> 00:15:30,139 I get to have lunch. 427 00:15:31,480 --> 00:15:33,500 I get to go home on time, 428 00:15:34,840 --> 00:15:35,980 and I'm not 429 00:15:37,000 --> 00:15:37,500 just 430 00:15:37,960 --> 00:15:40,700 going into this frenetic pace all day. 431 00:15:41,794 --> 00:15:43,154 One of the things that we look at, 432 00:15:43,154 --> 00:15:45,554 whether it's the sitting element, meaning patient safety 433 00:15:45,554 --> 00:15:47,954 attendant, the nursing element, or the physician element 434 00:15:47,954 --> 00:15:50,115 of virtual care, the goal here has been 435 00:15:50,115 --> 00:15:52,054 to reduce cognitive burden. 436 00:15:53,315 --> 00:15:53,815 Actually, 437 00:15:54,299 --> 00:15:56,299 we got that page from research that was 438 00:15:56,299 --> 00:15:59,360 done by NASA. The capacity to reduce mistakes 439 00:15:59,899 --> 00:16:03,500 and reduce risk is clearly associated with reduction 440 00:16:03,500 --> 00:16:06,059 of cognitive burden, which was a major focus 441 00:16:06,059 --> 00:16:06,720 for us. 442 00:16:07,595 --> 00:16:09,754 Our goal here, whether it's with nurses or 443 00:16:09,754 --> 00:16:12,634 physicians in virtual care, isn't to make them 444 00:16:12,634 --> 00:16:14,894 more productive, although that does happen, 445 00:16:16,394 --> 00:16:18,554 or simply just to reduce cost, which has 446 00:16:18,554 --> 00:16:19,534 clearly occurred. 447 00:16:19,914 --> 00:16:21,694 The bigger threat in my mind, 448 00:16:22,399 --> 00:16:23,779 I look at two lines. 449 00:16:24,960 --> 00:16:28,320 There is the line basically demonstrating the sheer 450 00:16:28,320 --> 00:16:30,160 number of individuals who are going to be 451 00:16:30,160 --> 00:16:33,040 Medicare eligible by 2030, and that's just going 452 00:16:33,040 --> 00:16:35,220 up, and it's sixty seven million people. 453 00:16:36,264 --> 00:16:39,144 And another line that's not very good and 454 00:16:39,144 --> 00:16:40,044 concerning is 455 00:16:40,585 --> 00:16:41,725 by 2030, 456 00:16:43,304 --> 00:16:45,804 the average age of physicians 457 00:16:46,424 --> 00:16:47,879 is gonna be one of the the highest, 458 00:16:47,879 --> 00:16:50,840 meaning closest to retirement that we've ever seen 459 00:16:50,840 --> 00:16:51,340 before. 460 00:16:52,040 --> 00:16:53,420 So as we're peaking 461 00:16:53,879 --> 00:16:55,500 on our Medicare age population, 462 00:16:56,840 --> 00:16:59,180 we are peaking in a population of physicians 463 00:16:59,399 --> 00:17:00,139 and nurses 464 00:17:01,695 --> 00:17:03,714 who are going to be considering retirement. 465 00:17:04,095 --> 00:17:04,994 These tools 466 00:17:05,535 --> 00:17:06,515 aren't just about, 467 00:17:07,615 --> 00:17:09,394 you know, what we have to do 468 00:17:09,775 --> 00:17:12,674 to sustain our care. These tools are 469 00:17:12,974 --> 00:17:14,355 very specifically about, 470 00:17:14,809 --> 00:17:16,490 I need to make sure that people wanna 471 00:17:16,490 --> 00:17:17,710 keep on being 472 00:17:18,490 --> 00:17:22,029 physicians and nurses and more prominently stated, 473 00:17:22,490 --> 00:17:24,410 physicians and nurses who actually wanna work in 474 00:17:24,410 --> 00:17:25,069 the hospital. 475 00:17:25,450 --> 00:17:26,750 Because working in a hospital 476 00:17:27,464 --> 00:17:28,285 is an incredibly 477 00:17:29,224 --> 00:17:30,285 challenging experience 478 00:17:30,904 --> 00:17:32,845 daily and certainly over time. 479 00:17:33,304 --> 00:17:35,704 So a major focus for us is how 480 00:17:35,704 --> 00:17:37,944 do we reduce the cognitive burden that's going 481 00:17:37,944 --> 00:17:40,125 to allow us to retain our workforce? 482 00:17:40,744 --> 00:17:42,444 So they want to be in the hospital. 483 00:17:43,359 --> 00:17:44,640 I know you wanted to so that's the 484 00:17:44,640 --> 00:17:46,559 whole story on virtual care. I know you 485 00:17:46,559 --> 00:17:48,579 wanted to get into other elements of AI, 486 00:17:49,839 --> 00:17:50,339 which 487 00:17:51,200 --> 00:17:52,659 if you thought it was going to be 488 00:17:54,400 --> 00:17:55,299 rather transactional 489 00:17:55,759 --> 00:17:56,259 and 490 00:17:56,934 --> 00:17:59,414 boringly pragmatic on virtual care. You should see 491 00:17:59,414 --> 00:18:01,434 how boringly pragmatic I am on AI. 492 00:18:02,214 --> 00:18:03,815 Absolutely. I love it. No. I I think, 493 00:18:03,815 --> 00:18:05,734 you know, especially looking at AI, there's so 494 00:18:05,734 --> 00:18:08,455 much opportunity right now, to become more efficient 495 00:18:08,455 --> 00:18:09,515 as a health system, 496 00:18:09,839 --> 00:18:11,839 and to deliver health care better, but it 497 00:18:11,839 --> 00:18:14,400 it doesn't always take that transformational, you know, 498 00:18:14,400 --> 00:18:16,579 huge pie in the sky ideas are really 499 00:18:16,799 --> 00:18:19,359 big problems that are simple solutions, but make 500 00:18:19,359 --> 00:18:21,279 such a big difference and have a real, 501 00:18:21,279 --> 00:18:22,515 real impact on, 502 00:18:22,914 --> 00:18:24,914 patient care and how the organization is running. 503 00:18:24,914 --> 00:18:26,515 So I'd love to hear some of the 504 00:18:26,515 --> 00:18:28,275 things that you've been doing in ways you've 505 00:18:28,275 --> 00:18:30,775 been looking at AI, that is truly beneficial 506 00:18:30,835 --> 00:18:31,815 across the board. 507 00:18:32,195 --> 00:18:32,934 AI Scribe. 508 00:18:33,714 --> 00:18:34,529 Full stop. 509 00:18:35,650 --> 00:18:36,150 Okay. 510 00:18:37,410 --> 00:18:39,029 And we'll get into that for a reason. 511 00:18:39,330 --> 00:18:41,910 But when you think of what clinicians 512 00:18:42,930 --> 00:18:44,070 if you start ranking, 513 00:18:44,450 --> 00:18:45,490 like, when they get to the end of 514 00:18:45,490 --> 00:18:47,269 their day and they're like, today was awful 515 00:18:47,554 --> 00:18:49,234 if they had an awful day. Like, why 516 00:18:49,234 --> 00:18:50,755 was today awful? Tell me why today was 517 00:18:50,755 --> 00:18:51,255 awful. 518 00:18:51,634 --> 00:18:53,255 They will talk about documentation 519 00:18:54,355 --> 00:18:55,634 and the amount of time they have to 520 00:18:55,634 --> 00:18:56,535 put into that. 521 00:18:57,554 --> 00:19:00,035 On the physician side, it's what they have 522 00:19:00,035 --> 00:19:02,214 to deal with in terms of authorizations. 523 00:19:04,059 --> 00:19:05,840 And what's gotten lower on the list 524 00:19:06,619 --> 00:19:08,320 would be malpractice concerns. 525 00:19:09,580 --> 00:19:10,880 And the fourth would be 526 00:19:11,500 --> 00:19:14,240 just like the sheer flood of patients 527 00:19:14,859 --> 00:19:16,480 who have higher acuity conditions. 528 00:19:17,684 --> 00:19:19,464 If you're gonna ask those kind of questions, 529 00:19:19,525 --> 00:19:21,065 like, twenty years ago, 530 00:19:22,724 --> 00:19:23,784 you wouldn't find 531 00:19:24,085 --> 00:19:25,544 the malpractice concerns 532 00:19:26,085 --> 00:19:27,765 and just the sheer flood of volume and 533 00:19:27,765 --> 00:19:29,845 high acuity patients at the bottom or the 534 00:19:29,845 --> 00:19:31,204 closer to the bottom of the list. They 535 00:19:31,204 --> 00:19:32,579 would be at the top of the list. 536 00:19:32,980 --> 00:19:34,759 They have been supplanted by 537 00:19:35,299 --> 00:19:37,079 just the sheer grind 538 00:19:38,019 --> 00:19:38,839 of documentation 539 00:19:39,299 --> 00:19:39,799 burden. 540 00:19:40,740 --> 00:19:42,500 And, you know, when you look at all 541 00:19:42,500 --> 00:19:44,759 of the payers out there, okay, 542 00:19:45,174 --> 00:19:47,654 you know, you start tracking what's going on 543 00:19:47,654 --> 00:19:49,815 on their stock price, you're gonna start seeing 544 00:19:49,815 --> 00:19:52,134 something that's not very shocking, and it's that 545 00:19:52,134 --> 00:19:54,714 their denials activity and their authorization activity 546 00:19:55,414 --> 00:19:56,795 goes off the hook. 547 00:19:57,769 --> 00:20:00,169 And that means physicians have to spend that 548 00:20:00,169 --> 00:20:00,669 time 549 00:20:01,849 --> 00:20:04,490 working through that. Now what's really, really important 550 00:20:04,490 --> 00:20:06,089 to appreciate here is when you're looking at 551 00:20:06,089 --> 00:20:07,549 the payers, they are 552 00:20:08,009 --> 00:20:09,789 exquisitely connected into 553 00:20:10,169 --> 00:20:10,829 AI activities 554 00:20:11,369 --> 00:20:12,589 to to basically 555 00:20:14,144 --> 00:20:16,725 demand request for information relative to an authorization 556 00:20:16,865 --> 00:20:19,585 or request for information for inpatient versus observation 557 00:20:19,585 --> 00:20:21,505 status. And what we're going to get into, 558 00:20:21,505 --> 00:20:23,105 and this is the most comedic element of 559 00:20:23,105 --> 00:20:24,705 all of it, you're gonna have AI tool 560 00:20:24,705 --> 00:20:25,924 versus AI tool. 561 00:20:26,960 --> 00:20:29,140 Spy versus spy. Okay? So 562 00:20:30,160 --> 00:20:31,380 but that's 563 00:20:31,920 --> 00:20:34,400 one component. The AI scribe component that's so 564 00:20:34,400 --> 00:20:34,900 meaningful 565 00:20:35,680 --> 00:20:37,539 goes back to cognitive burden 566 00:20:38,080 --> 00:20:38,980 and the pragmatism 567 00:20:39,279 --> 00:20:40,660 of retaining your workforce. 568 00:20:41,394 --> 00:20:43,414 Now right now, AI Scribe focuses 569 00:20:43,875 --> 00:20:45,494 overwhelmingly on physicians 570 00:20:46,115 --> 00:20:47,015 and their clinics. 571 00:20:47,954 --> 00:20:49,815 And here's what we saw. Okay? 572 00:20:51,315 --> 00:20:53,095 There are a number of very good tools. 573 00:20:53,474 --> 00:20:54,775 We happen to use Ambiance. 574 00:20:55,154 --> 00:20:55,654 Okay? 575 00:20:56,920 --> 00:20:59,099 To that end, here are our results. 576 00:21:00,519 --> 00:21:01,019 So 577 00:21:01,559 --> 00:21:02,299 with that, 578 00:21:02,920 --> 00:21:05,880 clinicians are, without even trying to, seeing about 579 00:21:05,880 --> 00:21:07,400 one to one and a half more patients 580 00:21:07,400 --> 00:21:08,059 a day. 581 00:21:08,535 --> 00:21:10,375 We weren't looking for that. Remember, our goal 582 00:21:10,375 --> 00:21:11,994 here isn't to make them more productive. 583 00:21:12,934 --> 00:21:14,875 Our goal here is to reduce burnout 584 00:21:15,335 --> 00:21:16,555 and retain them 585 00:21:17,335 --> 00:21:19,914 because there is going to be a time 586 00:21:20,630 --> 00:21:22,170 where if you aren't showing 587 00:21:22,630 --> 00:21:25,690 what you are doing for physicians in general 588 00:21:26,150 --> 00:21:27,529 to improve their workflows, 589 00:21:28,710 --> 00:21:31,029 and we'll finish up on that, you're not 590 00:21:31,029 --> 00:21:32,250 going to have 591 00:21:32,710 --> 00:21:33,769 a medical staff. 592 00:21:34,884 --> 00:21:37,944 So we brought in AI Scribe activities specifically 593 00:21:38,565 --> 00:21:39,224 to drive 594 00:21:40,164 --> 00:21:40,664 retention, 595 00:21:41,045 --> 00:21:44,424 reduce burnout, reduce cognitive burden, and that happened 596 00:21:44,884 --> 00:21:46,105 right out of the gate. 597 00:21:46,619 --> 00:21:48,700 Like, we went from a 100 physician pilot 598 00:21:48,700 --> 00:21:50,799 to commitment towards 900 clinicians. 599 00:21:51,819 --> 00:21:52,319 Like, 600 00:21:53,420 --> 00:21:56,799 my CEO was getting texts from physicians saying 601 00:21:57,740 --> 00:22:00,539 things like, I saw 17 patients before lunch 602 00:22:00,539 --> 00:22:02,474 today, and I know it was before lunch 603 00:22:02,474 --> 00:22:04,394 because I've never gotten lunch in the last 604 00:22:04,394 --> 00:22:06,575 five years, and I actually got lunch today. 605 00:22:06,634 --> 00:22:08,955 You'll be getting texts from, I'm actually at 606 00:22:08,955 --> 00:22:11,355 home having dinner with my family. Go back 607 00:22:11,355 --> 00:22:13,295 to the virtual nursing piece. 608 00:22:14,299 --> 00:22:15,819 What hit them in terms of why they 609 00:22:15,819 --> 00:22:17,019 love it is because it hit them in 610 00:22:17,019 --> 00:22:18,859 the field. For the nurses was I get 611 00:22:18,859 --> 00:22:20,700 lunch, I go home on time, and it's 612 00:22:20,700 --> 00:22:22,079 the same thing for the docs. 613 00:22:23,579 --> 00:22:25,740 And they can say things like, I'm actually 614 00:22:25,740 --> 00:22:28,734 having conversations with my patients. And these AI 615 00:22:28,734 --> 00:22:30,835 systems are so effective in their mapping. 616 00:22:31,214 --> 00:22:33,454 They're actually creating far better notes than they 617 00:22:33,454 --> 00:22:34,835 were ever creating before. 618 00:22:35,615 --> 00:22:37,454 So, sure, the E and M coding also 619 00:22:37,454 --> 00:22:38,194 went up. 620 00:22:39,454 --> 00:22:39,954 So, 621 00:22:40,255 --> 00:22:41,954 you know, very confidently, 622 00:22:43,200 --> 00:22:44,419 we are going to be 623 00:22:45,200 --> 00:22:47,599 at a breakeven from this. And that's without 624 00:22:47,599 --> 00:22:50,079 even getting into the kind of MA contracts 625 00:22:50,079 --> 00:22:52,079 that are coming in the future where RAF 626 00:22:52,079 --> 00:22:54,019 scores are really going to matter 627 00:22:54,640 --> 00:22:56,900 and what you're basically doing to 628 00:22:57,825 --> 00:23:00,224 achieve certain population health metrics that are gonna 629 00:23:00,224 --> 00:23:02,704 be valuable to an MA contract with your 630 00:23:02,704 --> 00:23:03,444 RAF scores, 631 00:23:03,984 --> 00:23:04,964 that's when 632 00:23:05,904 --> 00:23:08,384 the AI scribe tools are really going to 633 00:23:08,384 --> 00:23:10,799 be showing their benefit. Like, generating, like, a 634 00:23:10,799 --> 00:23:13,059 four or five, six x ROI 635 00:23:13,679 --> 00:23:16,339 versus a one and a half x ROI 636 00:23:16,400 --> 00:23:18,160 right now, but it is more than paying 637 00:23:18,160 --> 00:23:18,819 for itself. 638 00:23:19,519 --> 00:23:21,619 What's gonna happen next, though, is 639 00:23:22,294 --> 00:23:25,414 we have to bring that technology into the 640 00:23:25,414 --> 00:23:27,914 hospital, and you're going to see that with 641 00:23:28,134 --> 00:23:30,234 hospitalists and ED attendees. 642 00:23:31,815 --> 00:23:33,595 That will also pay for itself. 643 00:23:33,894 --> 00:23:35,835 But if we're really going to have 644 00:23:37,109 --> 00:23:38,970 a next step in the hospital, 645 00:23:39,430 --> 00:23:41,269 it's gonna be about how AI scribes are 646 00:23:41,269 --> 00:23:43,670 getting into nursing documentation, and that is a 647 00:23:43,670 --> 00:23:45,210 hot area of 648 00:23:45,509 --> 00:23:46,730 development for us 649 00:23:47,349 --> 00:23:49,509 because I worry a lot about being able 650 00:23:49,509 --> 00:23:51,049 to recruit physicians. I do. 651 00:23:51,644 --> 00:23:53,565 I worry infinitely more about being able to 652 00:23:53,565 --> 00:23:54,384 recruit nurses. 653 00:23:55,805 --> 00:23:56,305 Okay. 654 00:23:57,404 --> 00:23:58,465 Where are we at? 655 00:23:59,085 --> 00:24:01,585 Absolute that's fantastic. And, you know, definitely, 656 00:24:02,125 --> 00:24:03,884 makes a lot of sense. I appreciate you 657 00:24:03,884 --> 00:24:06,539 talking through AI and looking at even what 658 00:24:06,539 --> 00:24:08,220 the next steps are for the future. Are 659 00:24:08,220 --> 00:24:09,039 there any other, 660 00:24:09,500 --> 00:24:11,580 you know, big challenges that you see trying 661 00:24:11,580 --> 00:24:12,960 to tackle next with technology? 662 00:24:14,539 --> 00:24:15,360 Getting paid? 663 00:24:16,779 --> 00:24:17,519 That's important. 664 00:24:19,345 --> 00:24:20,865 When I think of the kind of systems 665 00:24:20,865 --> 00:24:22,305 that are out there, like, here's an area 666 00:24:22,305 --> 00:24:23,985 of health care that we just generally are 667 00:24:23,985 --> 00:24:26,465 not good at, and I'm actually really policing 668 00:24:26,465 --> 00:24:29,105 my language right now. Like, we just aren't 669 00:24:29,105 --> 00:24:31,365 good at it. And that's vital signs. 670 00:24:31,745 --> 00:24:33,365 And it's funny because they're vital. 671 00:24:34,440 --> 00:24:34,940 But 672 00:24:35,240 --> 00:24:38,440 to actually improve the deterioration indexes that exist 673 00:24:38,440 --> 00:24:40,039 out there and there's some really, really good 674 00:24:40,039 --> 00:24:42,299 ones. There's the stuff in Epic. Cerner's developing 675 00:24:42,359 --> 00:24:44,759 some. You know, you've got another product out 676 00:24:44,759 --> 00:24:47,579 there called AlertWatch. I mean, they're really, like, 677 00:24:48,200 --> 00:24:49,579 they're all really good, 678 00:24:50,945 --> 00:24:52,965 but they all require fuel. 679 00:24:53,904 --> 00:24:54,884 And the fuel 680 00:24:55,664 --> 00:24:58,005 would be a flood of data, 681 00:24:58,384 --> 00:25:01,025 and the best data of all for these 682 00:25:01,025 --> 00:25:03,445 deterioration indexes are vital signs. 683 00:25:05,640 --> 00:25:07,420 So we need to have actual technologies, 684 00:25:08,039 --> 00:25:09,420 and not just in the ICU, 685 00:25:10,600 --> 00:25:12,140 that can monitor a patient. 686 00:25:12,519 --> 00:25:14,539 And the and it's funny. The most 687 00:25:15,320 --> 00:25:18,380 my new my favorite vital sign is respiratory 688 00:25:18,440 --> 00:25:20,855 rate, which is ironic because for most clinicians, 689 00:25:20,855 --> 00:25:22,694 they snicker and say, yeah. The respiratory rate 690 00:25:22,694 --> 00:25:25,115 was sixteen, eighteen, or 20. Don't ask. Okay? 691 00:25:26,134 --> 00:25:27,035 What it's not, 692 00:25:27,894 --> 00:25:31,095 the subtleties in respiratory rate, we have found 693 00:25:31,095 --> 00:25:33,174 with the technologies we use, and anyone who 694 00:25:33,174 --> 00:25:34,799 wants to know what the technologies we're using 695 00:25:34,799 --> 00:25:36,259 are can look us up. Okay? 696 00:25:36,960 --> 00:25:40,000 But it's the ability to capture respiratory rate, 697 00:25:40,000 --> 00:25:42,400 heart rate, even skin body temperature, and one 698 00:25:42,400 --> 00:25:44,259 day blood pressure and pulse ox 699 00:25:45,759 --> 00:25:46,500 every minute 700 00:25:47,654 --> 00:25:50,375 allows for these systems to see the subtle 701 00:25:50,375 --> 00:25:51,434 changes in either 702 00:25:51,815 --> 00:25:53,975 increases in these rates or decreases in these 703 00:25:53,975 --> 00:25:55,735 rates. And when that occurs and when it 704 00:25:55,735 --> 00:25:58,295 actually happened more and more, you know, compressed 705 00:25:58,295 --> 00:25:59,035 over time, 706 00:26:00,289 --> 00:26:02,929 those patients who are showing those changes are 707 00:26:02,929 --> 00:26:03,429 actually 708 00:26:04,049 --> 00:26:06,230 demonstrating a higher risk for 709 00:26:06,690 --> 00:26:07,190 eventually 710 00:26:07,890 --> 00:26:10,630 compromising their overall condition requiring critical care. 711 00:26:11,329 --> 00:26:12,549 Okay. Getting paid. 712 00:26:13,244 --> 00:26:15,585 The ability to actually have that technology 713 00:26:16,204 --> 00:26:18,384 to monitor those patients more effectively, 714 00:26:19,005 --> 00:26:20,865 to use those DI tools, 715 00:26:21,484 --> 00:26:24,444 you need automated patient monitoring, having the vital 716 00:26:24,444 --> 00:26:24,944 signs 717 00:26:25,244 --> 00:26:26,545 flow into those systems 718 00:26:27,150 --> 00:26:29,009 not four times a day, 719 00:26:29,630 --> 00:26:32,049 but 12 times an hour. 720 00:26:33,630 --> 00:26:35,250 So it is a voluminous 721 00:26:35,549 --> 00:26:37,710 change in how we execute on care to 722 00:26:37,710 --> 00:26:39,809 identify the deteriorating patient. 723 00:26:40,595 --> 00:26:42,615 It's like comparing the Pony Express 724 00:26:44,195 --> 00:26:45,255 to a cell phone. 725 00:26:46,275 --> 00:26:47,015 And that's 726 00:26:47,394 --> 00:26:47,894 absolutely 727 00:26:48,195 --> 00:26:49,335 within our reach, 728 00:26:50,195 --> 00:26:51,954 and the feds have to figure out how 729 00:26:51,954 --> 00:26:53,335 they're going to pay for that 730 00:26:53,670 --> 00:26:55,690 because that kind of wearable technology, 731 00:26:56,070 --> 00:26:57,830 you will then wear at home. Now for 732 00:26:57,830 --> 00:26:59,930 what it's worth, the rural health fund, 733 00:27:00,230 --> 00:27:01,750 there is no such thing as any of 734 00:27:01,750 --> 00:27:03,509 the states applying for the rural health fund 735 00:27:03,509 --> 00:27:06,150 dollars without including something along the lines of 736 00:27:06,150 --> 00:27:06,650 wearables. 737 00:27:08,045 --> 00:27:10,125 Where I think it's a little misguided is 738 00:27:10,125 --> 00:27:12,204 you're talking about the general utilization of wearables. 739 00:27:12,204 --> 00:27:13,244 I'm like, no. No. No. No. I mean, 740 00:27:13,244 --> 00:27:15,164 there's a value for that, but it's not 741 00:27:15,164 --> 00:27:17,644 nearly the value of you just had a 742 00:27:17,644 --> 00:27:20,204 patient leave the most expensive place on planet 743 00:27:20,204 --> 00:27:21,984 Earth in health care, and that's a hospital. 744 00:27:22,309 --> 00:27:24,150 You wanna make sure that they don't have 745 00:27:24,150 --> 00:27:26,650 to come back at least for thirty days, 746 00:27:27,429 --> 00:27:29,990 if not longer. So the wearable technology, in 747 00:27:29,990 --> 00:27:32,089 my view, will be much more, 748 00:27:33,190 --> 00:27:35,349 generous in creating return on investment for the 749 00:27:35,349 --> 00:27:37,509 federal government if they're saying it's wearables from 750 00:27:37,509 --> 00:27:39,024 hospital to home. 751 00:27:40,204 --> 00:27:40,704 So 752 00:27:42,125 --> 00:27:44,204 a a challenge there is getting to that 753 00:27:44,204 --> 00:27:45,184 next component, 754 00:27:45,964 --> 00:27:48,065 which is on cognitive burden. 755 00:27:48,845 --> 00:27:50,365 So it was, what do we have to 756 00:27:50,365 --> 00:27:51,424 do to load balance? 757 00:27:53,099 --> 00:27:55,039 What do we have to do to needing 758 00:27:55,259 --> 00:27:55,759 capacity? 759 00:27:56,140 --> 00:27:57,259 What do we have to do to load 760 00:27:57,259 --> 00:27:59,900 balance and capabilities across an enterprise? And then 761 00:27:59,900 --> 00:28:01,599 the third element here is, 762 00:28:01,980 --> 00:28:02,799 in the trifecta, 763 00:28:03,180 --> 00:28:04,700 how are we doing a better job of 764 00:28:04,700 --> 00:28:05,200 identifying 765 00:28:05,660 --> 00:28:07,944 the deteriorating patient? Because there is not a 766 00:28:07,944 --> 00:28:09,005 nurse out there 767 00:28:09,704 --> 00:28:10,204 anywhere 768 00:28:11,384 --> 00:28:13,244 who goes through a whole week 769 00:28:13,704 --> 00:28:14,605 without worrying 770 00:28:15,065 --> 00:28:16,444 a decent amount about 771 00:28:17,865 --> 00:28:19,784 who's the patient that I'm not going to 772 00:28:19,784 --> 00:28:20,284 see 773 00:28:21,320 --> 00:28:23,480 about to go down the tubes? There's no 774 00:28:23,480 --> 00:28:26,279 hospitalist or ED doctor out there who doesn't 775 00:28:26,279 --> 00:28:27,640 go on the shift and being like, which 776 00:28:27,640 --> 00:28:29,320 one is the one that's going to catch 777 00:28:29,320 --> 00:28:30,140 me off guard? 778 00:28:30,680 --> 00:28:32,940 So being in a situation where you have 779 00:28:33,320 --> 00:28:33,820 literally 780 00:28:34,444 --> 00:28:36,845 technology that's watching your back to help you 781 00:28:36,845 --> 00:28:40,305 identify the deteriorating patient fours before you could 782 00:28:41,244 --> 00:28:42,944 is the third leg of the stool. 783 00:28:43,884 --> 00:28:45,424 We have to balance capacity, 784 00:28:46,125 --> 00:28:47,345 the volume of patients, 785 00:28:48,179 --> 00:28:48,679 capabilities, 786 00:28:49,139 --> 00:28:51,779 the resource to take care of highly acutely 787 00:28:51,779 --> 00:28:52,440 ill patients, 788 00:28:52,899 --> 00:28:55,319 and finally, the ability to identify the ones 789 00:28:55,460 --> 00:28:56,279 who are deteriorating. 790 00:28:56,899 --> 00:28:59,240 Those three things that we're trying to address 791 00:28:59,700 --> 00:29:02,904 greatly reduce cognitive burden, sustain our staff, and 792 00:29:02,904 --> 00:29:05,164 we feel like we have found sustainable models 793 00:29:05,384 --> 00:29:07,224 to pay for this stuff. And I want 794 00:29:07,224 --> 00:29:08,744 more people to know that because we need 795 00:29:08,744 --> 00:29:10,125 more people doing this work. 796 00:29:10,904 --> 00:29:13,785 Doctor Campbell, that's amazing insight and certainly such 797 00:29:13,785 --> 00:29:16,589 a strong, strong reminder of what's truly important 798 00:29:16,649 --> 00:29:19,690 and how technology can next really benefit what 799 00:29:19,690 --> 00:29:21,450 you're doing in the patient care level as 800 00:29:21,450 --> 00:29:22,509 well as for providers. 801 00:29:23,130 --> 00:29:24,970 I really appreciate your time today, doctor Campbell, 802 00:29:24,970 --> 00:29:26,730 and look forward to talking with you again 803 00:29:26,730 --> 00:29:27,230 soon. 804 00:29:27,769 --> 00:29:29,950 Alright. Thank you. Take care, Laura.