Transcripts For CSPAN2 Jag 20240706 : vimarsana.com

CSPAN2 Jag July 6, 2024

And cardiac electrophysiology fellowships at mass general, and also earn a doctorate from oxford university, a master of sites in clinical investigation from m. I. T. Harvard, and a Research Fellowship at the frames home heart study. Dr. Singh is an a internationaly recognized scientist, educator and lecturer, and serves as an advisor to multiple medical device and ai companies. Joining him in conversation is jim morelli, a general assignment reporter for boston 25 news. Jim fregosi worked as a freelance correspondent for cnn, specializing in medical stories out of the boston area. Jim is a graduate of the Massachusetts College of pharmacy in boston, and he also holds a masters degree in Civil Engineering from tufts university. O jim is the author two nonfiction books, one of which, poison, how to handle the Hazardous Substances in your home, generated and appeared on the Oprah Winfrey show. Tonight, dr. Jag singh is presenting his new book, future care sensors, Artificial Intelligence, and the reinvention of medicine. In this book dr. Singh explores the ups will a virtual caracol the evolving role of sensors, and impact of Artificial Intelligence in medicine and healthcare through cutting edge assignments, big idea projections, and patient stories. Future care provides us an insight into how health care can become sensible, affordable, and practical, and what agoa needs to become a part of the solution. It is an important and timely contribution to the ongoing and increasingly urgent conversation about medicine, technology, and healthcare. Jane moran, chief information digital officer at mass general brigham says of this book, future care resonates with my experience leading digital and Information Technology at mass general brigham, and isnd quite honestly a template for all Digital Health strategy. Dr. Singh shows the virtual carv and Digital Health on not only the future of medicine, but can transform healthcare as we know it. He rightly highlights how digital capabilities can help move the practice of medicine from treatment to wellness and prevention. And most importantly, bring equity to healthcare. We are so pleased to host this event here at Harvard Book Store tonight. Please join me in welcoming dr. Jag singh and jim morelli. [applause]an thank you. Thank you, natasha. For really taking the time to be here at 7 p. M. On a work evening. And its incredible that youre taking the time. Thank you all. I want to start by thanking jim for being here and again, taking the time. He has a busy schedule. Hes managed to work me into it. I want to thank the howard big scott bookstore and natasha most of all, cspan for for this recording. So delighted to be here. So were going to do this as i thought. Ill just spend 7 to 10 minutes or so just giving an overview, probably what natasha has already said in a different way and do a short reading of one of the chapters just, just three or four minute reading to kind of give a flavor of what the stories within the book look like. And then well have a fireside chat without a but will light up the fire. Jim mock q a me and then well talk and then well open up to the audience for another 15, 20 minutes. So you guys ask questions. Feel free to even stop us in the middle of. Our dialog. Feel free to stop me the middle of what im going to be saying. So happy to be interrupted. It gives me time to think then so. But thank you for being here. So let me let me really start with a little introduction just to kind of i natasha already mentioned this, but i would really like to tell you who i am, where im from, because that gives you an idea of where im going or how i perceive the field evolving. So i grew up in india i, i practiced medicine for a few years after, training in india. Then i moved across, did my doctorate at oxford, and i ended up here in the us at mass have been at mass general for the last 25 years with training through there. So im a part of the woodwork out there. At least i like to think so until they excavate me out and the reason i bring that up is that ive in three different environments ive worked within the indian environment, which is a Resource Limited environment. I worked the uk, which is a resource constrained and ive worked in the which at mass general is as a well resourced environment and you know, all of them have their nuances and each of them have their advantages. But i can tell you that none of them work really well. But im going to focus our discussion today on primarily the us system and how we can advance the us system. This future care strategies that talking about with the intent of eventually providing Global Equity because i think thats the far reaching goal that all of us are aspiring towards. So, so with respect, you know, starting on, on the us Healthcare System, i think its important to recognize is that it is big but its also fat and sick and. I think its fat and sick because almost 20 of our gdp or 17 to be exact, or 4 trillion to be even more exact of our gdp Goes Towards Health care, which is larger than. The you know, the the i would say the economy of some of the most developed nations in europe. And despite we have issues in terms of inexplicable costs really high mortality. I mean, Life Expectancy is actually much lower than many of the other countries. And when we start looking at the quality of care metrics, were fairly indefensible. And i think much of that is because we are to some extent and i it pains me say that we are inept, we are ineffective, we are inequitable. To start off with. And moreover, system is very opaque. Our system is very opaque because its opaque in how we reimburse medicine. Its opaque in the way medicine is pract just because theres a lot of variance in practice across the country, across hospitals, across institutions, across the same region. And that in itself inflates the cost and i think thats been a big, big issue out there. So medicine right now. And the reason im excited is a state of transition. We are having this digital transition, right . And this digital metamorphosis will actually enable us to enhance the delivery of care and make it more equitable. And i think its possible now because we do have we do have unlimited connectivity now. We have massive Processing Power and we have ubiquitous data. And putting that together, we now have an opportunity of enhancing how we deliver. And with this Digital Strategies, the care is immutable. So that makes it very transparent and at the same time makes the cost of it also fairly transparent. And i think putting all these things together, there is hope in the future and the future of care as we look at it today. Now, the soul of this book is really in forecast, dying and predicting disease. And i think that is largely if i can leave you with one message today, that would be that the future of care will be partially virtual will be sensor aided will be powered by Artificial Intelligence or Predictive Analytics which, sustainable workflows in the hospitals that will translate into better outcomes. So i know its a long twisted sentence, but there are three components to it. Basically virtual care sensors, Artificial Intelligence and workflows, simple strategy. And lets break it down. Im going to break it down very quickly because i know there are time constraints out here to really get the discussion going. I think the most important thing is is the is is the sensor strategy. And i think all of us already are well immersed in the sensor strategies. Those are variable sensors. Theyre watching their earbuds, their necklaces, their caps. All of them provide Digital Information in that same brand is realme. There is the implantable sensors that i as implant devices, patients and these devices that pacemakers and defibrillators have sensors within them that provide us information regarding physical activity of lung fluid give idea of what their temperatures can and whether they are going to have an impending event in the near future. And some of these sensor strategies can also help us predict Heart Failure in patients well before it actually occurs. Right now, the important thing, sensors, is and this is really interesting understand is that every sense in our body, every analog experience we have touch, temperature, pain color. These are digital experiences, right . Because they are all sequenced in binary codes. Every cell in our body, electrical activity, every cell is connected to the other cell through electrical activity. And these binary codes are these analog perceptions, digital signals that go to our cpu or gpu or whatever you want to call it, our processing up here, which is really the interface of all these digital signals. And thats why i think sensor strategies allow us the opportunity of creating organ specific sensors that can create appropriate digital dashboards, that can allow us to look after patients in a very individualized way. Now, the next part is very quickly is, is you get all this data from all these sensors implantable and wearables. And, you know, for a spectrum of disease states. But how do you kind manage that data . And theres really nice quote that you can have. You can have data without information in which you cannot have information without data. So its so important to actually be able to use that data appropriately in managing our patients and giving the right kind of care to them. So the question is, what is that data . So i think the data we all recognize is the data that is there in our Electronic Medical, right. We all know all all our age, sex, demographic data, medicines all that stuff is there. We recognize that. But theres this whole invisible data now that we dont recognize that really is the bigger contributing to disease and that is social, cultural, Environmental Data from the wearables right now is still something that is dark to us because its not all integrated into Electronic Medical records right now. But there are strategies that are developing, can layer it. So will be approaches that we will be using a. I. To look at, not only the visible but also the data because we know machine eyes can things that we cant see. And just to give you an example now you can look at a simple electrocardiogram a 12 lead ekg and you predict which patients are going to develop atrial relation, which patients are going to life threatening arrhythmias, which might actually develop a stroke in the future from a single standard to a lead. There are algorithms now that are being developed that can help us predict events in the future. Now if you put together with many other diagnostic imaging modalities, you can only imagine that the perfection of actually being able to predict things in the future actually gets enhanced considerably more very quickly. I think its really important that alongside the the the use of sensors and ai there have to be in how we use these technologies to manage care change care and thats youre going to have many future models of and i look forward to chatting about them. But one of the standard approaches that we actually as cardiologists already in patients who have implanted is something an exception based care. Its a new concept but that is care. That is given only when the patient actually needs it. So if you have sensors that can actually continuously surveil patients, it is only when those parameters are out of whack that you say, okay, i to bring the patient in and see the patient so you dont have to see the patient. Six monthly 12 monthly, two yearly intervals when theyre not unwell but see them at the time that they actually need to be seen through the strategy of exception based care and i think thats a concept of medicine that is gradually and i think as we get more to sensor based approaches, better predictive strategies using Artificial Intelligence, we will be using some of these continuous approaches where we can provide timely care at the right time, the right person at the right location. Okay, this is beyond cardiology. This is every possible disease state, whether its diabetes, hypertension or chronic obstructive disease, has the opportunity of providing continuous tracking using sensors and approaches to actually provide individualized care. Now, beyond, there are these whole concepts that we can delve into and wired which is there in the book. Its called manage your own disease, because i think health care is nonsense, sustainable. It is nonsense attainable unless patients have some skin in the game, it is impossible to manage disease for patients. But if you allow patients and empower patients or allow patients to empower themselves to actually help manage their disease, it is the only way that medicine can actually become sustainable. And some of these sensor based strategies, a ai based algorithm that will allow individualized output patients can enable some that care. Im not going to get the details of digital twins but we can talk that thats the next future of how you can actually create virtual replicas of individuals out here. Some of this is already happening. We are already creating of individual organ states. So you decide whether a certain intervention is going to translate into a better outcome. But you can imagine digital twins which are virtual replicas in physiology. The anatomy biochemistry along molecular and genomic information that. You can actually simulate disease and, test the ability of an intervention to if it actually makes a difference. So really stuff out there and the last thing im going to touch on is the current existing care strategy of systems that we see where all the hospitals and their affiliate and their Surgical Care centers are all integrated into, a system largely to enhance cost efficiency and effectiveness of delivery of care. The next era is going to be networked this way. The social order of medicine is actually going to change. And this is going to change because of the expectations of patients. This is going to change because. Our patients are going to are going to expect that they get care wherever. They are whenever they want, for whatever they want, wherever that location may be. And thats the future of where medical care will eventually go. I know that seems like utopia at this point in time, but there is a drift towards net network ness already. So im going to start by saying that, you know, we can talk about all these phenomenal and i think its cool stuff, but these are all to the human touch and the human bond. They cannot replace the empathy and the human touch that we encounter as clinicians every day. And you as clinicians or patients to on a daily basis, i think medicine always will will will have that human there. And id like to close off by this really nice saying from Francis Peabody who says that the secret of care lies in actually caring for the patient. And i think that can only be possible if the human touch is preserved while you use all these sensor based strategies and ai based outages to provide care. So with that, im going to conclude my my sermon, but im going to actually go on to do a short reading of the book so i can we can then sit down, just have a chat so that okay, thank you for bearing with youll have to continue, to hear me for another three, three and a half minutes. So i picked up, you know, i almost dropped the book down, said which, which page opens up. So i picked up one of the ones on creating the air culture this is chapter 11. And this is a little, you know, so every, every chapter in the book i write about 20, 25 or so, all of them start with patient stories and their intertwined with how those patient stories translate into how outcomes and Clinical Care needs to evolve. Right . So it kind of provides that. So theyre peppered with stories all over. So this one starts with this quote from, charles lindbergh, who says is like a landscape. You live in the midst of it, but can describe it only from the Vantage Point of distance. Okay. I met victoria for the first and last time in the of 2019. She was a 73 year old. Strikingly majestic black woman who had air of confidence that made it clear me that she was the matriarch and the boss of her family. She was here to see me with, her 24 year old granddaughter, alice, her chaperon for the day. I had been asked by Oncology Team to see victoria for increased shortness of breath and swollen, supposedly early manifestations of a weak heart. But she clearly had bigger problems that day. Victoria was wearing a long sleeved light yellow tshirt, imprinted with several faces, intrigued by her t shirt and in an attempt to break the ice, i asked her about the faces was wearing. I was taken aback when she introduced of the seven faces as our family members, three brothers, two sisters and two daughters, and began recounting how each of them had died of either of cancer or Heart Disease. She carried them around with her on this personal journey said that it gave her faith strength and continually reminded her to be grateful for every time. She might have. She might still have. She also told me that she was not afraid of going to the other as she knew they would be waiting for her. She pointed out that alice was accompanying her today, had herself survived leukemia at the tender age of seven and was studying to be nurse victoria now had recurrent Breast Cancer. Shed been diagnosed 25 years ago received chemotherapy. And since then she had had two surgeries with a left breast mastectomy and reconstructive surgery. Her weak heart now most likely a result of the chemotherapy, had received. She what we call a classic case of the triple whammy. First, cancer, now cancer again, and then Heart Failure. She was told that she had a recurrence in her right breast with evidence metastases to the lungs and signs of fluid building up around her lungs

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