1
00:00:00,215 --> 00:00:02,305
- This is Christos with the
Becker's Healthcare Podcast,

2
00:00:02,845 --> 00:00:04,905
and Jill will be joined
by Dr. Simon off top,

3
00:00:05,275 --> 00:00:06,265
chief Strategy Officer

4
00:00:06,365 --> 00:00:07,705
for Nicholas Children's Health System.

5
00:00:08,085 --> 00:00:10,145
Dr. Off Top, thank you so
much for joining us today.

6
00:00:11,005 --> 00:00:12,035
- Thank you for having me.

7
00:00:12,785 --> 00:00:14,715
- Wonderful. Could you
please introduce yourself

8
00:00:14,715 --> 00:00:15,955
and tell us a bit about your background?

9
00:00:17,425 --> 00:00:21,555
- Sure. Um, as you just shared,
um, my name is Simon Aftab

10
00:00:21,555 --> 00:00:23,555
and I serve as the Chief Strategy Officer

11
00:00:23,575 --> 00:00:24,795
at Nicholas Children's.

12
00:00:25,495 --> 00:00:27,835
Um, I am a physician by training

13
00:00:27,935 --> 00:00:29,595
and I've been with Nicholas Children's

14
00:00:29,815 --> 00:00:31,035
for about seven years.

15
00:00:31,855 --> 00:00:33,955
Um, I've trained as a pediatrician

16
00:00:34,055 --> 00:00:35,675
and then as, as a neonatologist.

17
00:00:35,935 --> 00:00:37,675
And I started out my,

18
00:00:37,735 --> 00:00:40,555
off my career at the Children's
Hospital of Philadelphia

19
00:00:40,685 --> 00:00:41,835
where I did all my training

20
00:00:42,495 --> 00:00:44,275
and I was a faculty member at the

21
00:00:44,275 --> 00:00:45,395
University of Pennsylvania.

22
00:00:46,095 --> 00:00:48,955
And then, uh, after 11
years, I moved to Boston

23
00:00:49,255 --> 00:00:51,115
and I was at the Harvard
School of Medicine.

24
00:00:51,735 --> 00:00:52,835
So, uh, you know,

25
00:00:52,835 --> 00:00:55,195
my career was started
off in clinical medicine

26
00:00:55,415 --> 00:00:57,835
and, um, you know, education,

27
00:00:58,415 --> 00:00:59,875
the traditional academic track,

28
00:00:59,935 --> 00:01:01,835
and then got into healthcare consulting

29
00:01:01,855 --> 00:01:04,115
and then, uh, healthcare administration.

30
00:01:04,655 --> 00:01:06,075
And I got an MBA

31
00:01:06,735 --> 00:01:09,115
and, uh, over time transitioned into more

32
00:01:09,115 --> 00:01:11,075
of a strategy, business development role.

33
00:01:11,615 --> 00:01:14,075
And, uh, I've been serving
in this role at Nicholas

34
00:01:14,235 --> 00:01:15,875
Children's for now seven years.

35
00:01:16,175 --> 00:01:17,835
And, um, I love what I do

36
00:01:18,055 --> 00:01:19,595
and I love the fact

37
00:01:19,595 --> 00:01:21,275
that I can bring both the worlds together,

38
00:01:21,465 --> 00:01:24,075
both my experience at
the bedside as well as

39
00:01:24,545 --> 00:01:28,035
that business development,
uh, strategy arm

40
00:01:28,035 --> 00:01:30,995
that helps us do a better job,
you know, connecting the two,

41
00:01:31,135 --> 00:01:33,315
um, at, at, at our, at
our Children's hospital.

42
00:01:34,995 --> 00:01:36,715
- Excellent. Thank you for
sharing all of that, doctor.

43
00:01:36,935 --> 00:01:38,795
So given your current role,

44
00:01:39,125 --> 00:01:41,755
technology definitely
plays a huge part of that.

45
00:01:42,255 --> 00:01:44,235
So with that in mind,
could you let us know

46
00:01:44,305 --> 00:01:46,515
what technology shows
the most promise in terms

47
00:01:46,515 --> 00:01:49,275
of its application over
the next 12 to 24 months?

48
00:01:49,735 --> 00:01:53,195
And on a related note, everyone
is buzzing about AI these

49
00:01:53,195 --> 00:01:56,595
days and pretty much any
business or any venture.

50
00:01:56,815 --> 00:01:58,435
And so how would you describe Nicholas

51
00:01:58,595 --> 00:01:59,675
Children's approach to ai?

52
00:02:01,265 --> 00:02:02,465
- Absolutely. I think, uh,

53
00:02:02,645 --> 00:02:04,425
you pretty much hit the nail on the head.

54
00:02:04,705 --> 00:02:06,625
I think everyone's buzzing about ai

55
00:02:06,765 --> 00:02:08,545
and we too, um,

56
00:02:08,645 --> 00:02:10,585
at Nicholas Children's
are very excited about the

57
00:02:10,585 --> 00:02:12,705
opportunities it has to offer.

58
00:02:13,445 --> 00:02:16,265
So in the short term, I think
in the next 12 to 24 months,

59
00:02:16,425 --> 00:02:19,145
I think obviously, you
know, the, the boost

60
00:02:19,145 --> 00:02:20,985
that telemedicine got through covid,

61
00:02:21,225 --> 00:02:22,705
I think is only going to continue.

62
00:02:23,245 --> 00:02:24,585
And at our healthcare system,

63
00:02:24,585 --> 00:02:28,025
really integrating it across
the care continuum for patients

64
00:02:28,025 --> 00:02:30,705
and for our children, I think
is going to be a priority.

65
00:02:30,885 --> 00:02:34,905
So how does that translate
into better home monitoring?

66
00:02:34,905 --> 00:02:36,585
What's our home healthcare strategy?

67
00:02:36,725 --> 00:02:38,305
How do we integrate telemedicine

68
00:02:39,205 --> 00:02:40,745
for managing population health

69
00:02:40,805 --> 00:02:43,625
and keeping our kids healthy
at home and in their schools?

70
00:02:44,365 --> 00:02:47,105
And then obviously the
other sort of big component

71
00:02:47,175 --> 00:02:50,065
that I think we're excited
about in the short term is going

72
00:02:50,065 --> 00:02:52,225
to be the applications for ai.

73
00:02:53,085 --> 00:02:56,425
Um, so I think when we think
about that, um, you know,

74
00:02:56,605 --> 00:02:59,765
the central focus for that
would be how can we use AI

75
00:02:59,765 --> 00:03:02,885
to improve patient about the
quality of patient care as well

76
00:03:02,885 --> 00:03:04,365
as enhancing the experience.

77
00:03:05,385 --> 00:03:08,405
And even today, there's a lot of solutions

78
00:03:08,585 --> 00:03:11,845
for available AI driven
solutions that can actually

79
00:03:12,635 --> 00:03:16,565
enhance the, not only the
quality of patient care,

80
00:03:16,745 --> 00:03:18,125
but also the experience.

81
00:03:18,185 --> 00:03:20,925
And the, the, the area that
we're gonna be focusing on

82
00:03:20,945 --> 00:03:23,685
to start is going to be around imaging

83
00:03:23,705 --> 00:03:24,965
and radiology services.

84
00:03:25,225 --> 00:03:28,365
So we are already doing a
pilot where, um, with a,

85
00:03:28,415 --> 00:03:31,045
we're using AI technology
to determine bone age,

86
00:03:31,545 --> 00:03:34,325
and that's going to be our
first sort of, you know,

87
00:03:34,325 --> 00:03:36,245
dipping our toe in the water, so to speak.

88
00:03:36,385 --> 00:03:39,325
But I think there's countless
additional applications

89
00:03:39,385 --> 00:03:40,925
for AI both in the clinical

90
00:03:40,925 --> 00:03:43,925
and non-clinical space that,
that we're very excited about.

91
00:03:46,705 --> 00:03:48,215
- Thank you, doctor. So beyond that,

92
00:03:48,275 --> 00:03:50,295
are there other in innovations rather,

93
00:03:50,325 --> 00:03:52,855
that Nicholas Filters is excited
about over the next year?

94
00:03:54,965 --> 00:03:58,805
- Absolutely. Um, there's,
we're, uh, investing in some, uh,

95
00:03:59,145 --> 00:04:02,405
AR and VR solutions both
for medical training,

96
00:04:02,435 --> 00:04:03,605
patient education,

97
00:04:03,745 --> 00:04:05,525
and improving the patient experience

98
00:04:05,525 --> 00:04:07,445
through difficult procedures,

99
00:04:07,445 --> 00:04:11,485
through really creating a very
interactive, uh, fun journey.

100
00:04:11,685 --> 00:04:13,085
I think the best part of pediatrics is

101
00:04:13,085 --> 00:04:15,005
that you can have a lot of fun and,

102
00:04:15,025 --> 00:04:17,605
and be creative, um, in, in terms

103
00:04:17,625 --> 00:04:19,045
of using these technologies.

104
00:04:19,265 --> 00:04:21,045
So one of the things that we've started

105
00:04:21,045 --> 00:04:23,765
to implement is using VR technology

106
00:04:24,145 --> 00:04:26,485
and, um, sort of the, the, um,

107
00:04:26,945 --> 00:04:29,165
and ification to sort of get our patients

108
00:04:29,165 --> 00:04:32,005
to be more compliant, um,
either through a procedure

109
00:04:32,185 --> 00:04:34,045
as we're guiding them
through the different steps

110
00:04:34,305 --> 00:04:37,245
so they don't get anxious,
but also with education.

111
00:04:37,425 --> 00:04:39,805
So for kids that, um, have diabetes

112
00:04:39,905 --> 00:04:42,045
and need to manage their own health, um,

113
00:04:42,145 --> 00:04:46,045
in any other chronic complex
condition, you know, using AR

114
00:04:46,045 --> 00:04:50,205
and VR to sort of be, um,
a very fun interactive tool

115
00:04:50,425 --> 00:04:52,685
for kids to actually learn
how to take ownership

116
00:04:52,765 --> 00:04:55,725
of their own health,
um, is is very exciting.

117
00:04:57,765 --> 00:04:59,985
- Doctor on that, no, what
has the feedback been like

118
00:05:00,045 --> 00:05:02,905
for this, uh, program that
you've just described for us?

119
00:05:03,785 --> 00:05:06,115
- Yeah. Feedback for the
program has been great.

120
00:05:06,695 --> 00:05:08,995
Um, both our patients, our clinicians

121
00:05:08,995 --> 00:05:10,715
and our staff absolutely love it.

122
00:05:10,715 --> 00:05:14,395
They've been very open
to the, the technology

123
00:05:14,615 --> 00:05:16,515
and incorporating it in the workflows.

124
00:05:16,855 --> 00:05:19,635
But beyond that, the data
that we've collected so far,

125
00:05:20,085 --> 00:05:24,675
especially for the, the US
using virtual reality for, uh,

126
00:05:25,035 --> 00:05:28,075
patients and coming patients
through procedure, we found

127
00:05:28,075 --> 00:05:29,675
that not only are we more likely

128
00:05:29,675 --> 00:05:32,515
to be successful in doing
the procedure without any

129
00:05:32,515 --> 00:05:35,275
complications, the number of interruptions

130
00:05:35,335 --> 00:05:37,915
or the time to complete the
procedure is actually better

131
00:05:38,385 --> 00:05:40,875
with integrating, um, this VR tool.

132
00:05:41,095 --> 00:05:44,035
So the feedback has been
excellent across the board.

133
00:05:48,835 --> 00:05:51,555
- Excellent. Thank you,
doctor. So taking a little bit

134
00:05:51,555 --> 00:05:53,675
of a different direction here.

135
00:05:53,855 --> 00:05:57,235
So I understand that Nicholas
Re's last year, November

136
00:05:57,835 --> 00:06:00,475
specifically joined a
coalition dedicated to advocacy

137
00:06:00,735 --> 00:06:02,595
for underserved populations
around the world.

138
00:06:03,025 --> 00:06:06,315
This is definitely a noteworthy
goal that any health system

139
00:06:06,975 --> 00:06:08,195
and should have, but

140
00:06:08,215 --> 00:06:10,835
how do you see your own health
system role in this effort,

141
00:06:11,055 --> 00:06:12,955
and how would you encourage
others to get involved?

142
00:06:15,255 --> 00:06:17,335
- Absolutely. So Nicholas Children's, um,

143
00:06:17,505 --> 00:06:19,615
we're formerly known as Miami Children's,

144
00:06:19,615 --> 00:06:21,815
so we're the largest
freestanding children's

145
00:06:22,015 --> 00:06:23,095
hospital in South Florida.

146
00:06:23,915 --> 00:06:26,375
And we also have the
privilege of taking care

147
00:06:26,375 --> 00:06:28,575
of kids not only in our local community,

148
00:06:28,955 --> 00:06:30,935
but a sizable number of kids

149
00:06:30,935 --> 00:06:34,215
that are coming from the
Caribbean, from the South Americas

150
00:06:34,515 --> 00:06:35,855
and from all over the world.

151
00:06:36,075 --> 00:06:39,855
So we truly consider
ourselves an advocate globally

152
00:06:39,995 --> 00:06:41,175
for pediatric healthcare.

153
00:06:42,075 --> 00:06:43,855
Um, so Nicholas Children's, um,

154
00:06:43,955 --> 00:06:46,295
and our roles as a part
of this coalition would be

155
00:06:46,515 --> 00:06:47,895
to really be that advocate

156
00:06:47,915 --> 00:06:50,255
and that void for, for the health

157
00:06:50,255 --> 00:06:51,615
of children all over the world.

158
00:06:52,495 --> 00:06:55,455
I think we are uniquely
positioned through our experience

159
00:06:55,455 --> 00:06:58,255
with our patients that
come from a very broad part

160
00:06:58,255 --> 00:07:02,775
of the globe for us to be, you
know, um, closely keyed into

161
00:07:02,775 --> 00:07:05,015
what those issues are
for children globally.

162
00:07:05,725 --> 00:07:07,295
They may be a little bit different from

163
00:07:07,295 --> 00:07:09,775
what we experience here at home in the US

164
00:07:10,355 --> 00:07:12,095
but I think there's many common themes.

165
00:07:12,835 --> 00:07:15,975
So, um, advocacy around, uh, prevention

166
00:07:16,115 --> 00:07:19,455
of communicable diseases,
you know, vaccinations,

167
00:07:20,225 --> 00:07:21,655
clean water, but,

168
00:07:21,795 --> 00:07:23,495
but again, mental health is a theme

169
00:07:23,495 --> 00:07:25,655
that we're seeing both
not only in our local

170
00:07:25,655 --> 00:07:26,975
community but also globally.

171
00:07:27,195 --> 00:07:31,055
So a lot of advocacy efforts
are going to be focused around

172
00:07:32,055 --> 00:07:34,135
recognizing de-stigmatizing and,

173
00:07:34,435 --> 00:07:36,855
and really getting kids
the, the mental health, uh,

174
00:07:36,855 --> 00:07:39,855
support services needed
quickly and easily.

175
00:07:40,195 --> 00:07:43,455
So I think, you know, we're
excited about, um, you know,

176
00:07:43,935 --> 00:07:45,455
participating in this amazing coalition

177
00:07:45,455 --> 00:07:48,575
and providing, you know,
a contribution and, and

178
00:07:48,675 --> 00:07:50,895
and providing thought
leadership in that space.

179
00:07:52,575 --> 00:07:54,675
- Lastly, doctor, I wanted to ask you, so

180
00:07:54,675 --> 00:07:57,715
what issue in pediatric
care do you think deserves a

181
00:07:57,795 --> 00:07:59,675
brighter spotlight this year and beyond?

182
00:08:02,135 --> 00:08:05,375
- I think this year and beyond,
I think behavioral health

183
00:08:05,435 --> 00:08:08,935
or mental health is, I
think, the, the most pressing

184
00:08:09,715 --> 00:08:13,335
an important issue that we
are facing in pediatrics.

185
00:08:14,175 --> 00:08:17,175
I think, um, you know,
COVID-19, the pandemic

186
00:08:17,755 --> 00:08:20,695
really exacerbated, um, mental health

187
00:08:21,215 --> 00:08:23,575
challenges in our children,
in our, in our, our youth.

188
00:08:24,155 --> 00:08:26,495
Um, there's many contributing factors.

189
00:08:26,895 --> 00:08:28,975
I mean, overall, I think
year over year, even

190
00:08:28,975 --> 00:08:31,535
before the pandemic, we
had seen rising rates

191
00:08:32,035 --> 00:08:34,815
of mental health disorders
among children and adolescents,

192
00:08:35,235 --> 00:08:38,095
but then adding the isolation, distress

193
00:08:38,235 --> 00:08:40,455
and fear from, um, uh, uh,

194
00:08:40,455 --> 00:08:43,735
potentially lethal viral infection, um,

195
00:08:43,835 --> 00:08:47,615
and then add that with social
separation, academic pressure,

196
00:08:48,155 --> 00:08:50,575
and then the sort of
the, the negative effects

197
00:08:50,575 --> 00:08:53,335
of social media with bullying trauma

198
00:08:53,555 --> 00:08:55,725
and then also the stress
of family dynamics.

199
00:08:55,725 --> 00:08:57,845
And, um, at the time of the pandemic,

200
00:08:58,085 --> 00:09:00,205
I think really brought
things to a boiling point.

201
00:09:00,905 --> 00:09:03,405
And not only were it
really uncovered the fact

202
00:09:03,405 --> 00:09:07,445
that our healthcare systems
not only, uh, were ill-equipped

203
00:09:07,465 --> 00:09:08,885
and Ill staffed to take care of this,

204
00:09:08,905 --> 00:09:12,085
but also really recognizing
the whole continuum

205
00:09:12,345 --> 00:09:13,605
of mental health illness.

206
00:09:14,005 --> 00:09:15,685
I think it became very important.

207
00:09:15,865 --> 00:09:18,685
So really a focus on primary prevention.

208
00:09:18,785 --> 00:09:20,725
You know, talking about mental health

209
00:09:20,905 --> 00:09:24,925
and wellness with parents and
having school teachers and,

210
00:09:24,985 --> 00:09:27,165
and school systems to recognize their role

211
00:09:27,795 --> 00:09:30,885
integrating mental health
services in primary care offices

212
00:09:31,145 --> 00:09:32,445
or pediatricians offices,

213
00:09:33,145 --> 00:09:36,045
and then really up building
capacity for telemedicine

214
00:09:36,065 --> 00:09:38,005
and inpatient services for mental health.

215
00:09:38,745 --> 00:09:41,285
So it's going to need a
complete overhaul for us

216
00:09:41,285 --> 00:09:43,165
to really make a sustainable impact,

217
00:09:43,545 --> 00:09:46,005
and it won't be made possible
without really looking at

218
00:09:46,005 --> 00:09:47,325
where technology fits in

219
00:09:47,625 --> 00:09:49,085
and how we can do better in terms

220
00:09:49,105 --> 00:09:51,565
of policy change and advocacy.

221
00:09:52,065 --> 00:09:55,885
Um, so I think that that's just
the single biggest, I think,

222
00:09:55,885 --> 00:09:57,485
challenge for pediatric healthcare.

223
00:09:58,065 --> 00:10:00,525
And I think a close second
would be childhood obesity.

224
00:10:01,705 --> 00:10:03,785
I think obesity, you know, overall

225
00:10:03,785 --> 00:10:06,145
for us remains a significant
public health concern.

226
00:10:06,825 --> 00:10:11,585
I think, um, you know, the,
the statistics about only 20%

227
00:10:11,605 --> 00:10:16,225
of Americans were considered
obese, um, in the 19, in 1960s,

228
00:10:16,405 --> 00:10:18,825
but now about 40% of Americans are, are,

229
00:10:18,965 --> 00:10:20,265
are in that category.

230
00:10:20,885 --> 00:10:22,545
And it's particularly alarming

231
00:10:22,545 --> 00:10:25,225
because we're seeing similar
rates in our children as well.

232
00:10:25,965 --> 00:10:29,225
And as you can imagine,
the morbidities and,

233
00:10:29,245 --> 00:10:31,145
and the side effects that
come with childhood obesity,

234
00:10:31,695 --> 00:10:36,425
including diabetes, uh,
depression, social isolation,

235
00:10:36,485 --> 00:10:39,945
cardiovascular disease,
um, and other illnesses.

236
00:10:40,105 --> 00:10:43,345
I think, you know, we're setting
our kids up for a lifetime

237
00:10:43,525 --> 00:10:47,185
of poor health, poor mental health, lack

238
00:10:47,185 --> 00:10:49,185
of social relationships, lack of poor,

239
00:10:49,345 --> 00:10:50,385
a lack of self-esteem.

240
00:10:50,885 --> 00:10:53,625
So I think this in my mind,
is another one of those really

241
00:10:54,165 --> 00:10:56,385
hot topics that I think
we all need to sort

242
00:10:56,385 --> 00:10:59,065
of collaborate on and
find creative solutions

243
00:10:59,085 --> 00:11:01,625
to address in a, in a
significant and sustainable way.

244
00:11:03,285 --> 00:11:05,905
- Dr. Thank you so much
for being so generous

245
00:11:05,905 --> 00:11:07,305
with your time and your insights.

246
00:11:07,425 --> 00:11:09,545
I know we've covered a lot of
ground in this short period

247
00:11:09,545 --> 00:11:13,145
of time and we cannot wait
to share all your insights

248
00:11:13,145 --> 00:11:14,465
with our audience that we look forward

249
00:11:14,485 --> 00:11:15,825
to connecting with you soon.

250
00:11:17,825 --> 00:11:19,065
- I appreciate the opportunity

251
00:11:19,125 --> 00:11:20,665
and thank you so much for taking the time

252
00:11:20,845 --> 00:11:25,225
and, uh, as you can tell, I'm
very excited personally about,

253
00:11:25,365 --> 00:11:27,105
you know, all these new technologies

254
00:11:27,205 --> 00:11:29,385
and the opportunities
that it, it has to offer

255
00:11:29,405 --> 00:11:30,505
that's gonna help our kids.

256
00:11:30,645 --> 00:11:32,985
So I appreciate the opportunity to come

257
00:11:32,985 --> 00:11:33,785
and speak with you all.