<v Jordan Cooper>Hairstyle Chief digital evangelist and cofounder of Avera Health and Irma Rasta Gayaa, chief digital storyteller and cofounder of Avera Health. Evan Erma, thank you for joining us today.</v>

<v Evan Kirstel (Guest)>Thanks for having us.</v>

<v irmaraste>Things Jordan good to be here.</v>

<v Jordan Cooper>Sure. So the first question like to pose to you, since you are digital storytellers, digital evangelists, I'd like to ask you for my early about healthcare delivery systems and growing trends in the healthcare IT space as healthcare delivery systems and provider organizations begin to take on more risk for managing population health, engaging patients in their own care plan and driving healthy patient behaviors have taken on new importance. What sort of recommendations might you have for healthcare organizations?</v>

<v Jordan Cooper>Looking to generate digital content to engage your patient populations.</v>

<v irmaraste>Sure I can. I can take that one as a long term patient advocate, 30 plus years and there's an engaged empowered patient myself known as epatient. My recommendation to healthcare systems and the technology providers in general would be to engage one of the most important stakeholders which is patient population to engage them.</v>

<v irmaraste>Umm, as early as possible in the process of developing technology or deploying technology that they want to use to help patients. So one of.</v>

<v irmaraste>One of the complaints I hear often, including on social media and personal from patients, is that they are not brought in early enough in the process.</v>

<v irmaraste>And then they are offered solutions that might not be best to help them take control of their health. So that's suggestion number one is to get patient patients themselves and care partners involved in the process early on.</v>

<v irmaraste>Part 2 is to listen to ongoing feedback from patients as they are given.</v>

<v irmaraste>At tools documentation, uh training, education, etcetera, listen to that feedback. What's working for patients, what's not, what could be improved upon, what?</v>

<v irmaraste>They want more off when it comes to resources and education.</v>

<v irmaraste>I they are being considered as a role valuable partners in this whole healthcare enterprise.</v>

<v Jordan Cooper>So, Irma, I'm hearing you say that healthcare delivery system should engage patients early on and listen to feedback. How should what sort of content should healthcare delivery systems leverage to engage patients better?</v>

<v irmaraste>Well, I think that really depends on what.</v>

<v irmaraste>You know what stage of the process?</v>

<v irmaraste>Uh patients will be interacting with them with, so this is, is this the patient is a digital front door. Is it a patient education or specific condition? Is this something that patients will be given as a follow up to the visit or to the surgery for example, is it a care plan? So it really depends on what stage the of the engagement this is, this is happening. And so I think maybe I've been.</v>

<v irmaraste>Too much in the patient world and patient advocacy world from my perspective, maybe I'm diving too deep into this Evan from.</v>

<v irmaraste>Umm, your perspective of a patient that doesn't have so many touch points with the healthcare system, would you have a different perspective?</v>

<v Evan Kirstel (Guest)>Yeah. I think for me it's about education, you know, and consuming content that educates, informs and give me guidance. It's so confusing as a patient that technology, the terminology, the, the medical speak, the interacting with the healthcare system, even the apps and websites that we use can be pretty poorly designed. And so simplification education.</v>

<v Evan Kirstel (Guest)>Uh, communicating in everyday speak through video through the channels that we all know and are comfortable with, like text messaging and and apps in a.</v>

<v Evan Kirstel (Guest)>You know, in a consumable format and we have to sort of demystify the medical and healthcare systems for patients, so they can really.</v>

<v Evan Kirstel (Guest)>Uh, get direction, guidance and understand the, you know, their their you know healthcare process and that's sorely lacking in many of today's systems.</v>

<v Jordan Cooper>So I'm hearing that in order to engage patients, we have to engage them early, listen to feedback and provide them with education. I'd like to move on to other topics in the in the content that you've published digitally through a Viera health, you've listed a number of different trends that you've identified across the healthcare space that you see the health IT going in the United States. I was like to kind of punch through some of these items and see some of your thoughts. So one of these topics that you've mentioned.</v>

<v Jordan Cooper>It's connectivity and telemedicine you've written in particular about the effect of fifth generation or 5G technology on the healthcare industry, which is facilitating telemedicine applications to be more widely deployed and utilized for more conditions and use cases. How are these applications being leveraged by large healthcare delivery organizations? And where do you see that going?</v>

<v Evan Kirstel (Guest)>Well, it's it's going in a positive direction. I think 5G isn't just another G it, it's actually a complete new rethink of networking and communications infrastructure. If you go into your average hospital today, the Wi-Fi is pretty terrible. The indoor coverage is pretty bad. It's sometimes you can't get a signal, much less broadband or video to to allow inter, yeah, you know, hospital communications over video.</v>

<v Evan Kirstel (Guest)>Communication for for telehealth and 5G, particularly private 5G where you can have within a hospital system a private dedicated 5G network.</v>

<v Evan Kirstel (Guest)>It allows you to reinvent and refresh the entire healthcare IT infrastructure, which is usually pretty old. You know in terms of the wiring, in terms of the Wi-Fi network that's been put in place. And when you look at, you know, just look at intersystems in the amount of data that's generated, you need an advanced network to transmit and manage, store and interoperate and these require advanced networking technologies and 5G is you know the right time, the right place to.</v>

<v Jordan Cooper>Even.</v>

<v Evan Kirstel (Guest)>To upgrade that entire infrastructure and enable these services, Yep.</v>

<v Jordan Cooper>Evan, could you tell about some of the benefits and drawbacks of hospitals who are looking to implement 5G? What are some of the challenges and costs and what are some of the value propositions of investing in a new IT infrastructure with a in this case a particular private 5G network in a hospital?</v>

<v Evan Kirstel (Guest)>Well, it's it's it's a little bit new and novel. So it's not as off the shelf as Wi-Fi is where everyone can basically go and buy off the shelf components are almost like a Best Buy and deploy a network. So you need a you know a a partner who understands the 5G network and can design it specifically for your hospital environment. So that's a little bit new, but the benefits are you're taking advantage of an entire ecosystem, new apps, new devices kind of tablets, phones and other kinds of video endpoints.</v>

<v Evan Kirstel (Guest)>That can leverage this new kind of network, whether it's private or just the public network. And it means a better experience for the patients and the rooms, the visitors and you know, nurses, doctors and others trying to run the hospital increasingly on these outdated networks.</v>

<v Jordan Cooper>Have you found that any hospitals or healthcare delivery organizations have had improved quality outcome outcomes or improved returns on investment with investing in a 5G network or is that data is it is a whole system too new for there to have been quality metrics and outcomes that have been assessed with these private 5G networks?</v>

<v Evan Kirstel (Guest)>I think it's too new for specific outcomes. What we see we have seen major benefits in manufacturing and related industries, finance and financial tech where you know you basically overnight you can turn on just you know go from a spicket to a waterfall of of information carried over these networks and and increasingly you know it's it's the way forward. You're just gonna run into bottlenecks as you know increasingly video is used as we get more and more.</v>

<v Evan Kirstel (Guest)>Digital health applications as we have the Internet of Things on your body that generate data, you know today's networks just can't physically, you know, scientifically keep up with the amount of data being generated in the hospital between hospitals.</v>

<v Jordan Cooper>Let's talk about IIOT, who which for our listeners is industrial Internet of Things? How is the Internet of Things being leveraged in health, the healthcare setting today? And I also kind of wanna tie that into another topic that I know Irma and Evan, you've both previously covered in content that you published, which is mixed reality. You've mentioned there's a multitude of applications for augmented reality, virtual reality and mixed reality and medicine from training for medical students across many specialties to immersive learning.</v>

<v Jordan Cooper>Promote surgery and physical rehab and patient education. So where are you seeing these mixed reality applications and also throwing into the mix IoT?</v>

<v irmaraste>I conference.</v>

<v Evan Kirstel (Guest)>Yeah. Eric, do you wanna take a take a stab at that one, and I'll chime in.</v>

<v irmaraste>Yeah, I'll talk about I OT or not as industrial Internet of Things, but Internet of medical things, which is also one of the terms that we use in the industry. So and then I'll talk a little bit about 3D and virtual twins. And then Evan can finish up with the with that whole.</v>

<v irmaraste>Multiverse aspect potentially. Yeah. So Internet of medical things I think has become more wide, wide known term as well as IoT Internet of Things because of the rise in a variety of personal wearable devices that are collecting health data.</v>

<v irmaraste>And things that remote patient monitoring, which is actually been in existence for a decade or more but had gained more disability and more traction during the COVID pandemic. So remote patient monitoring for people who are not familiar, is the ability to do just that, monitor patients in their home settings are outside of the hospital, the doctor's office. And that could include collecting their vitals.</v>

<v irmaraste>Keeping track on their activity, their blood pressure with some devices like, you know, smart watches, perhaps even take a look at their.</v>

<v irmaraste>Umm, you know, heart health in terms of Cardiogram? Certainly you know, oxygen saturation was devices like the ordering, just some some of the examples. So we talked about all this connectivity and these devices talking over wireless networks.</v>

<v irmaraste>And you know.</v>

<v irmaraste>Wi-Fi just you know, that's the Internet of Things. Internet of medical things when you're we're looking at medical data and vitals. So I think there is a lot more work to be done from the healthcare systems perspective.</v>

<v irmaraste>To make sense of this data. So there is some some health related data that is just for patients to kind of look at to get a gauge of, you know maybe how many steps they've done, how is the activity level, what what kind of sleep are they getting? And then of course, there is really medical information that should be delivered to physicians for the remote patient monitoring. So I think there is a lot of work to be done to develop actionable insights from this data.</v>

<v irmaraste>And as well as find ways to fit the barrage of this data into current workflow of physicians and providers. So the goal here is of course to increase.</v>

<v irmaraste>The touch points between the healthcare system and the provider and the patient so that for chronic conditions like diabetes like heart disease, we don't have just the ones every few months touch point without having any visibility into what patients lifestyle.</v>

<v irmaraste>It is and how that affects their day-to-day health and well-being, whether that's being, you know, blood sugar level for diabetic, that thetics or the blood pressure etcetera. So so that's just one area I said I'll talk about virtual twins and this.</v>

<v Jordan Cooper>I like that pause for a second, Irma, and make this more concrete for our listeners. You mentioned a whole variety of different examples of how remote patient monitoring could be implemented today. I'm wondering if either of you have any anecdotes of these actually being implemented, either with customers or any other stories that you might know in order to make these use cases more concrete for our listeners.</v>

<v irmaraste>Well, maybe Evan. Uh, do you wanna talk a little bit about?</v>

<v irmaraste>Our friends is still life and how they use existing problem networks to gather a whole ton of patient data.</v>

<v irmaraste>Umm.</v>

<v Evan Kirstel (Guest)>Yeah, that, that that's a great example of that. And I think even you mentioned the aura ring, Erma, where big fans and where where the Warnock ring, which is a kind of health and Wellness ring wearable device that was actually used in a in a clinical setting with the NBA to actually monitor very, very sensitive temperature variations as a.</v>

<v Evan Kirstel (Guest)>Weighted, determined or detect early stage COVID and that was successfully used. You can look at you know just fractions of a degree in temperature over some number of days means you're likely you have likely have an illness, specifically COVID so you know, examples like that are being used in clinical settings in a variety of ways and in addition to being slowly accepted in mainstream use cases.</v>

<v Jordan Cooper>Thank you.</v>

<v irmaraste>And then the slightly different example of to give is you mentioned telehealth. So we haven't spoken specifically here about the telehealth, but there is a obviously applications of telehealth are many. So they probably the very simple example is just moving the patient encounter or visit to the doctor from in person to remote because of the COVID pandemic. That's that's how this has become so much more available.</v>

<v irmaraste>Now, almost every doctor offers that is an option, but what about telementoring? So we actually just spoke to the Chief nursing officer at Microsoft the other day, and they're using a lot of telementoring for nurses. So this is where a nurse, a less experienced nurse, particularly, could be a patient side, for example.</v>

<v irmaraste>In a hospital setting and then a much more experienced a specialized nurse could be brought in through telepresence to give guidance and to help in in, in training and advising that.</v>

<v irmaraste>That nurse, that is a bad side. So we see a lot of.</v>

<v irmaraste>Things like that. So that could also be in surgery you mentioned. So a lot of opportunities to bring in people together through virtual in virtual environments to offer advice, help training and then so just one other example I'll mention in terms of virtual twins. And then Evan can talk about more of the you know, the R extended reality applications. So I've just written about the virtual twin example of the living heart.</v>

<v irmaraste>Umm, so that is basically a digital model of of a human heart. In all the details, including, you know, the musculature, the innovation.</v>

<v irmaraste>Best blood vessels as well as all the dynamics of.</v>

<v irmaraste>You know everything that's in the heart system and that's being used now to train surgeons to plan for surgeries, especially pediatric surgeries. Given that almost every pediatric deformity is very different, it's not a standardized. So you need approaches to personalize that care. So I'll stop here. You know, we only have a few minutes left.</v>

<v irmaraste>Evan, you want to talk about extended reality applications?</v>

<v Evan Kirstel (Guest)>Yeah. I mean, people talk about the men of Earth, which has gotten mixed reviews, but increasingly the aspects of the metaverse, like augmented reality, virtual reality are being used today in real settings. Whether it's our favorite surgeon on Twitter, Raphael Grossman, who does.</v>

<v Evan Kirstel (Guest)>Planning of surgeries? Who does medical education and does patient communication through virtual reality headsets in in pre-op and post-op. They're amazing use cases of VR in all aspects of the kind of workflow, and this is real. This is being done today by surgeons. There's value add. There was, you know, the first Google Glass surgeon number of years back. And they've only progressed the use of the use.</v>

<v Evan Kirstel (Guest)>Wearable headsets for hands free surgery for.</v>

<v Evan Kirstel (Guest)>You, you know, creating a, you know, look database online accessible during surgery and and on and on. So you know what we think of as kind of the future and a lot of pipe is actually being deployed in practical reality today by surgeons.</v>

<v irmaraste>And of course, 5G is a very important enabling technology for for things like that.</v>

<v Evan Kirstel (Guest)>And medical robotics and other situations which are kind of Michael's mission critical like a, you know, an ER an OR and other other scenarios.</v>

<v Jordan Cooper>Thank you for addressing those different themes. We have a variety of other themes that I know you've listed. I just wanna list them out for our listeners since we won't have time to get to all them reducing employer healthcare costs, artificial intelligence, especially for early diagnostics and the radiology suite, digital therapeutics care personalization with 3D printing alternatives to opioids, connected healthcare we just covered and digitizing clinical trials. We only have a few minutes left of this particular podcast episode.</v>

<v Jordan Cooper>And again, keeping in mind are audience of healthcare delivery system, chief information officers and their staff. I'm wondering if you have any particular messages that you would want to convey to them about what's next around the corner? What are the challenges of implementing, what should they be? What steps should they be taking to make sure that they're hospital isn't left behind and remains on the cutting edge of where tech is today?</v>

<v irmaraste>Well.</v>

<v Evan Kirstel (Guest)>Well, I think I'm sorry. I'll, I'll just interrupt just to quickly suggest they go on social media and tap into these various communities on Twitter and LinkedIn, around Medtech and medical innovation. And they're amazing peers and colleagues and communities and organizations that are out there on social media, connecting, educating, sharing insights and networking. And so really is the upside of social media.</v>

<v Evan Kirstel (Guest)>It's about counter the bounce about and all the bad sides that we hear about every day. So you know, what do you think?</v>

<v irmaraste>What? Well, there's great segue. I'll ask for one thing that you hear a lot about on social media from patients and patient advocates and families access to patient records give us full access to our own medical records, make them interoperable. So it's actually possible to provide them for to other healthcare systems, other providers for second opinions for additional specialty care.</v>

<v irmaraste>Etcetera. So I know interpretability. He's been talked about for years and years and years and years with the new legislation just happened. We're looking forward to that becoming a much more streamlined and easy process for patients and that should definitely result in improved patient care once we have full access to our own patient records.</v>

<v Jordan Cooper>Well, thank you. And this has been another episode of Healthy Data. We've been joined by our guest, Evan Kirstel, chief digital Evangelist and cofounder, Riviera Health, and Irma Rastegayeva, chief Digital Storyteller and cofounder of Avira Health. Speaking about trends in digital health in the United States, where new technology is creating new opportunities to add value within healthcare delivery systems. So Evan Ermac like to thank you both for joining us today.</v>

<v irmaraste>Thank you so much.</v>

<v Evan Kirstel (Guest)>Thanks for having us. Thank you.</v>

<v irmaraste>Happy to be here.</v>