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Continuing our series of discussion from CHIME/HIMSS 2019 we hear from Dr. Nick van Terheyden where we discuss innovation, rediscovering foundations for health and the walking gallery.


This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Welcome to this week in Health it where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is Bill Russell recovering healthcare, c i o, and creator of this week in Health. It a set of podcasts and videos dedicated to training the next generation of health IT leaders.

This podcast is brought to you by Health Lyrics, helping you build agile, efficient, and effective health. It. Let's talk visit health to schedule your free consultation. We are recording a series of discussions with industry influencers at the Chime Hymns 2019 conference. Here's another of these great conversations.

Hope you enjoy. Okay, here we are from Chime. Uh, Nick, do you wanna introduce yourself? Hi, my name's Dr. Nick. I'm the incrementalist and I'm an emergency room physician, and I focus at the intersection between technology, healthcare, and business. So when we first met, uh, you're very active on social media.

When we first met you were with Dell, so you're now on your own. Uh, yes. So I'm running my own company. Sounds rather grand, but this is it. You see all of it. Um, uh, offering strategic advice, trying to find those small improvements, um, revolution through evolution. Um, don't let, uh, perfection stand in the way of progress.

Oh, absolutely. You can't innovate if you're looking for, Perfection or you know, big bang kinda stuff. You got it. And, and it's the lowest risk approach because if you make a mistake and you are trying to make for that big leap, that's a really costly mistake. Whereas if you go for those small steps and all the exponential companies all started with these incremental improvements, Uber, Airbnb, yeah.

So you, uh, I mean, do you consult with, uh, providers, payers, pharma, startups? I mean, where, where do you All of the above. Okay. I, I, I'm very fortunate in, you know, the 30 plus years that I've spent at this intersection point that I've been involved in companies, , Uh, that come from the small, the large, from multiple backgrounds.

And as I put it, I have multiple arrows, uh, in my quiver, right. To shoot at all of these opportunities. Yeah. Physician background, technology background, and uh, and the in innovation side can always use, uh, that perspective. 'cause you have all these people coming in from Silicon Valley saying, . Um, you know, we think we can change healthcare and, and they can really, I mean, what did I just say?

I just read two and a half billion was invested in healthcare in January. I, I'm not surprised by that, but I, I would strongly advocate . The involvement of clinicians, absolutely anything involved in, if you've got health anywhere in your company name or activities. If you don't have clinicians involved, I think you are missing the mark or you are going to potentially miss the mark.

That's an expensive mistake to make. I'm gonna, I'm gonna ask a, maybe a, uh, dangerous question here, but could traditional clinicians lead you down a wrong path, though? I, I think that's a fair comment. Um, you know, if you get stuck in, uh, the history of medicine and the way that we practice medicine, electronic health records are a great example of that.

I mean, what did we do? We essentially digitize the paper. System. Right. That wasn't the smartest thing in the world to do. Right. But yeah, and, and if, if you think about the physicians, that's what they would've said, well, this is how we do, we should go. And, you know, so there has to be some innovative thinking and you have to push people in that direction.

Some folks, others like me, I see 25 years ahead, I was doing population management at school, um, as my sixth form science prize. Wow. So let's talk about this conference. Uh, so HIMSS is a, is interesting. What, what do you, how do you do this conference? What are you looking for at this conference? So I just wanna say that's the understatement of the year, but otherwise, um, I mean, it is, it's the biggest.

Aggregation of healthcare, technology, innovation, all of these folks coming together, how do you plan 45,000 people? Right? How do you plan, how do you involve yourself? So I always come with a plan, but pretty much almost as soon as I arrive, I throw that plan out. The, the, the window. There's elements of this that are random.

Um, and I think you have to accept that, uh, Look for sort of small areas of focus that you're interested in, individuals that you're interested in, in meeting, um, it's a great opportunity. It can be challenging to do. And then find those opportunities where you can, uh, learn from others and engage with others.

So will you, uh, are there trends that you're gonna be keeping an eye on, that you're gonna be looking at those technologies? So I, I think we see an awful lot of the trends around artificial intelligence. You just have to look at the numbers of. Of sessions to know that cybersecurity is a top pick, uh, artificial intelligence, population analytics.

So all of that gives you a sense in my mind of, of if you think about the innovation cycle, they've all sort of moved over the peak of disillusionment and we're sort of moving. We hope I try and pick some of the things that are further out. Um, You know, where is technology going to take us? What are the opportunities?

What are the foundational things that I think is really going to hit us very hard is around sleep and sleep innovation. When I went to medical school, I was doing 136 hour week. There's only 150 something in the week, so that's a lot of hours. Huge sleep deprivation. It was clear that that was a. A major issue.

We fail to focus on that sufficiently. And it's not just a pillar of health, it's the foundation of health. How do we fulfill that obligation to our patients? Because one night, bad night of sleep is worse than missing your exercise for a week or eating five big Macs every day. And we heard this morning in the chime session, we heard about, um, isolation and lonely loneliness, and.

Its impact, uh, essentially the impact of loneliness is the equivalent of creating a chronic stress state in the body. And, uh, you know, and lack of sleep, is that also that other thing? So, you know, and that's a great point. If, if you think about loneliness, that's one of the torches that are used in, in warfare.

It's an awful concept. But, you know, given that that's an effective torture methodology, . We have to find means of communicating and connecting. And the thing about technology, one of the things that you'll see in Japan is they've led the way with some of these robots and innovation. And, and whilst that's technology, it turns out that that's actually companionship.

It's no different to having a pet. Not everybody can have a pet. We could all have some kind of robot that interacts with us, makes us feel good. Yeah, it simple solutions, you know, and it's, it's interesting 'cause sometimes you see those videos of the robot and whatever, and . You almost sort of, you chuckle at it.

But then, you know, my, my father-in-law comes to live with us. He's 87 years old, and he's interacting with, uh, with the echo, like it's his, his companion. And it almost is, it's like, Hey, what's going on in the news? What's going on in sports? Hey, can you play me some country music? I mean, it's, he's interacting with it all day, and that's not even a back and forth.

Right? But it's, it's, it, I, I think the important part of that is that you, you . Ibe an element of personality in those artificial agents, whether it's just a speech element in, in the case of the Echo and Amazon Alexa. Um, and you give them a sense of you. And one of the things that happens in these interactions is, I, I know something about you.

I've got some of the history, and I apply that to our conversation. If you do that with technology, it starts to be more engaging. It's, it's more human-like. You can't replace humans, but you can augment them. Well, let's talk about providers. So, You know, one of the things about providers is they could potentially get pigeonholed in terms of you're gonna be our, uh, place to go for episodic care and those kind of things.

But they have this opportunity to be the trusted partner in their communities if they can figure out how to break down the walls, right, and, and engage the community, engage people in their homes and those kind of things. Are there, are there different technologies you're looking at that they're, that a, a provider system is gonna be able to make those transitions?

'cause we're seeing the other players try to, I mean, you're seeing the, you know, the J P m, Amazon Berkshire, you're seeing, uh, you know, just C V SS Aetna. You're seeing other players saying, that's where we're gonna go. Are provider's gonna be able to get there? So I, I think what's old is new again, in my mind.

So when I was practicing medicine, we would do home visits. Right. We were embedded in the community. Why did we stop? Well, it was a cost issue. It was a challenge from a, um, a coordination standpoint. And you see some of the companies like CareMore who are inserting not just the physician, but all of the other, uh, groups into the community.

I think it's an essential component. The way that technology helps is not by replacing, but augmenting. So instead of you've got a limited set of resources, so we triage the same as I did in emergency medicine. You triage the patients coming through and deal with the ones that you have to deal with urgently.

Same with this, insertion into the uh, community. Find the ones that are desperately in need. Focus on those. You reduce their costs, improve their healthcare, do all of the good things, and then you can focus on the others. You've got more resources left as a result of that. So I think it's the combination.

People are terrified of this technology, but technology isn't gonna replace us. It allows us to do more and to process more information and deliver the best possible care all of the time. So, last question, culture, right? So I, I, I worked for a fairly large health system, uh, for about eight years. The, the, the culture of healthcare sort of just keeps going in a direction.

How do you. It's not that there aren't innovative people within healthcare. There's a ton, there was a ton of innovative people. Um, but how do you gather those people and create a movement within maybe a very traditional trajectory of a health system? So I, I, I sometimes use this analogy and I'm . I'm always a little bit concerned when I do because it has some negative connotations, but it's a bit like plutonium.

Plutonium's kind of interesting dispersed, but when you bring it together, you create something incredible and impressive and, and I think it's the same with all these resources. I, you know, nobody goes into work with the intent of delivering poor care and not caring about patients. It's just not the way that we were brought up.

You know, the individuals aren't built that way, so you have to facilitate the bringing together of those resources in an environment that encourages it. I'll, I'll pick just one simple example. Head of this punitive approach to medical errors taken a, a page out of the airlines, and I know they're imperfect, but for the most part it's a no fault activity.

We just saw a, a case just recently of a nurse being prosecuted. Uh, for a mistake that was made post an e h r implementation and an error. It it, did she come in intending to do that? I don't believe that. For one second, we have to find ways of supporting so that people feel confident to contribute and to enable them.

That for me is, is really . You, you've got all these resources. We just have to tap into them. They're desperate to deliver the best that they possibly can. Yeah, absolutely. Nick, thanks. But I, I do have to get a shot of your, the back of your jacket. Is there a story behind the back of your jacket? There is.

So this is the walking gallery. I, I'm very passionate about it. Um, uh, Regina. Um, created this, it was initially, as, you know, a, a painting on a wall, in fact, and every jacket tells a story, um, about an individual's journey and, and struggle. In fact, it's ironic that you, you pick this and I'll allow you to focus in.

So the story is me. So the hourglass and the, the sun and the moon represents time. Uh, the people in front of it are all my colleagues that I work with as a junior doctor. Um, that's me I think at the front. And then the lady on the top is a friend of mine who committed suicide, um, as part of that whole process.

Couldn't cope with 136. Showers and other things that went on. Um, you know, we all have a story to tell. We've all got a passion. Um, you know, I was enduring sleep deprivation. Uh, that was good for me in, in the days that I was experiencing it. Um, the concept of this is to. Have people have that conversation.

I was just at breakfast in a hotel and the uh, uh, receptionist there asked me about it. I got an opportunity to share the story. That's the purpose. Yeah. I, I just, my hat's off to Regina and the walking gallery. It's such a fantastic, um, that's phenomenal, um, experience. Thank you for your time. Really appreciate it.

Really enjoyed it. Thanks very much. Thank you. I hope you enjoyed this conversation. This show is a production of this Week in Health. It. For more great content, you can check out our website at Thanks for listening. That's all for now.

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