Perspectives on Health and Tech

Generative AI is a known disruptor in healthcare today. Will this transformational technology be embraced by clinicians, patients, and healthcare organizations? Listen in as two experts from Accenture Healthcare and Oracle discuss the difference between traditional AI and GenAI, the opportunities that GenAI is presenting to the industry, and the need to lean in to utilize technology as an enabler and a change agent. Hear how care delivery can be reimagined with GenAI and how this technology has the potential to be applied to help reduce clinician burnout, augment the clinician-patient relationship, bridge workforce shortage gaps, reduce margin pressure, and more. -------------------------------------------------------- Episode Transcript 00:00:00:17 - 00:00:22:10 Michelle You're listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data and technology to improve health for everyone. Hi, I'm Michelle Flemings. I'm the industry executive director for Health Care for North America Cloud Infrastructure at Oracle. Glad that you're here. We're in the age of artificial intelligence. 00:00:22:12 - 00:00:41:29 Michelle The opportunities that we're presented with using A.I. as an industry are truly groundbreaking. And to be honest, I think we're just getting started. I want to focus today on a subset of traditional AI and want to talk a little bit about generative AI, some of the ramifications, some of the risks, benefits and what does it mean to health care. 00:00:42:01 - 00:00:47:29 Michelle I am delighted to sit across today from Tej Shah and I'll have him introduce himself. 00:00:48:01 - 00:01:08:00 Tej Thanks, Michelle Tej Shah I'm an emergency medicine doctor, a managing director, and Accenture's global health care practice. I've got a ton of experience working across different parts of health care as a consultant, obviously, but also as a venture capitalist, investing in companies and most recently starting a company in the health tech space. 00:01:08:00 - 00:01:16:07 Michelle We're talking about AI and we always have to start with what is the comparison between traditional versus generative AI? 00:01:16:09 - 00:01:17:21 Michelle How would you put that? 00:01:17:23 - 00:01:41:11 Tej We've been talking about AI for 50 plus years. This is not a new thing. We've been talking about how we can leverage data to get insights going from analytics to AI to  GenAI. Really the difference is, you know, before with AI we were able to extract data and insights from data so we could figure out what the next obvious data point was going to be. 00:01:41:13 - 00:02:19:03 Tej And in 2017 there was an article that was published by Googlers around attention is all that matters, right? And what happened with that papers is we came up with a completely new framework where we're now able through  GenAI to not just predict what's the next data point, but understand what's the next word that we can generate. And it's taking into consideration the context of the sentence to be able to make that prediction so that it's actually appropriate and it's opened up a whole bunch of opportunities that we're going to talk about today that is really transformative. 00:02:19:05 - 00:02:30:03 Michelle Let's get into some of those opportunities. I think it's fascinating that it's been as  long ago that A.I. came about and the general public really doesn't know. 00:02:30:03 - 00:02:35:14 Michelle let's talk about some of the opportunities in patient care that exists because of where we are now. 00:02:35:14 - 00:02:40:28 Michelle With A.I.. We do a lot around documentation. Where else should we be going? 00:02:41:00 - 00:03:08:03 Tej Back in 1996, you know, we started using search engines and it wasn't really until early 2000 when Google came around and the search bot search box became our librarian and around that time there was an article that was published by Will Carr in The Atlantic called Is Google Making Us Stupid and what he really meant. 00:03:08:03 - 00:03:33:29 Tej when you read the article was, are we thinking differently? Are we using our brains in the same way or reading as deeply as we did before? And obviously the answer is no. I think we continued to use our brains and we continue to, but we were using this tool as a librarian. We were using it to identify information quickly and be able to access it, you know, more readily. 00:03:34:01 - 00:04:04:19 Tej And what GenAI has done for us is start to be an advisor. It's enabling this transformation from technology, being a librarian to an advisor and that's what we're using AI for now. And GenAI today, right? So this idea of documentation and this is all relevant because the next sort of wave of what we're going to do with GenAI is it's going to start to act as an agent. 00:04:04:21 - 00:04:30:28 Tej It's going to start to enable us to take these tasks away from the from our day-to-day workflows and enable us to operate more efficiently. There is no reason, for instance, that a doctor like you or I should have to, you know, once we've submitted that a patient needs to do a specialist appointment, continue to follow up, make sure that that appointment was scheduled and have a bunch of people that are in that workflow follow up on it. 00:04:31:01 - 00:04:49:27 Tej It should just happen. And I think that generative AI is going to create these agents and these agents are going to be linked to one another. We're going to chain them together and it's going to do that follow up. It's going to make that experience more seamless, really enabling clinicians to do the work that gives us joy. 00:04:49:29 - 00:05:07:07 Michelle Let's drill down on that now, because you said something fascinating there being an agent. How I see it as being is now, I don't have that extra chaos and clutter to remember. As an ER doc, we're in the midst of the chaos we are in and we're trying our best to multitask. And there are fewer of us now. 00:05:07:10 - 00:05:25:16 Michelle There are others that are doing an exit now and then. We also don't have as much of a pipeline because, as you know, some of our residency programs didn't fill out. So three years from now, we're talking a massive deficit. And across the board in health care, there has been an exodus and a shift out of health care to other careers. 00:05:25:19 - 00:05:45:23 Michelle How do you see then us utilizing Gen AI to augment and maybe bridge some of those gaps with our shortages? The agent is great, but can we maybe think about a couple of other things that maybe might be even more magnificent? Like it's maybe front office, back office? Is there opportunity there, you think? Because we don't think about them a lot. 00:05:45:23 - 00:05:47:04 Michelle I do believe, absolutely. 00:05:47:04 - 00:06:10:27 Tej So let me just start. The clinician shortage is durable and it's secular. This is something that I say over and over again. You know, we have projected forward what we anticipate the workforce in health care is going to look like. We know there's going to be a shortage. But if you look at some of the research that's being published now, just at the end of last year, there was a study that published that looked at nurses and doctors that are in school today. 00:06:10:27 - 00:06:43:15 Tej And, you know, you might know that of those surveyed students, between 20 and 30% of them said they're going to drop out. They don't see the future of health care as a promising career that they want to pursue. That's going to be fulfilling in the way that maybe when we were going to school, we saw. And I think that's really disheartening because truly I think that, you know, when the way I thought about health care and the way the reason I pursued a degree is because I wanted to take care of people. 00:06:43:18 - 00:07:05:18 Tej And what's happened along the way is so many things get in the way of that, Right. That joy that we were talking about that I mentioned, that's gone because we've got so much administrative burden, so many distractions that sort of pull us away from that day to day care. It's actually started to deteriorate or continue to deteriorate. 00:07:05:18 - 00:07:28:18 Tej That relationship between the doctor and the patient that I think is so sacrosanct. It's so important. And I think patients want it. Physicians want it that nurses want it back. And so when I think of front office and back office, it's not just agents that are going to be doing this work. What it's going to do is it's going to take those tasks away, but it's also going to start to transform. 00:07:28:25 - 00:07:55:11 Tej What role, as a clinician, I play in the delivery of care, right, where maybe 30, 40% of my time I was it was taken up by doing that administrative work. Now I'm going to have it back to refocus on the patient. And it doesn't just drive productivity improvement, it drives greater engagement, it drives better experience for us as clinicians and for patients. 00:07:55:13 - 00:08:19:10 Michelle So back on Joy, I would love to be back there as well, cause I remember that feeling my first, but the patients and I could do anything and everything and this was going to be magnificent. And then you're right. Little by little, the administrative stuff started to become a burden. With GenAI,, how do you see us being able then, in this world of technology, having unfortunately had that adverse effect? 00:08:19:10 - 00:08:45:15 Michelle And I think it was an unexpected consequence of all of the information coming into the EHR and all of the information coming at us, period, whether it's on our phones, on our on our laptops and still faxes and message centers and inboxes. How do you see Gen AI as being able to be the thing that we can get providers to say, I trust this, I'm going to buy in, I will do this. 00:08:45:17 - 00:08:51:16 Michelle Because the last time we petted the dog, that was technology, it bit us and we have a long memory. 00:08:51:19 - 00:09:23:16 Tej Yeah, you know, the EMR is a beautiful thing, right? It actually transformed and improved the quality of care. It helped us, you know, document how we were taking care of our patients and enabled us to move patients seamlessly from one provider to another. But you're absolutely right. When you look at the data around the impact to productivity of the EMR, there's a 13% reduction in clinician productivity because of it. 00:09:23:18 - 00:09:51:05 Tej And I think, as you said, clinicians have been burned by it. I think we feel as though we were betrayed. We feel as though, you know, it didn't help us do our jobs better. It didn't help us improve the relationships that we have with our patients. And I think as we think about deploying new technology into care delivery, we're going to have to do a much better job of articulating the value proposition of what the technology is. 00:09:51:07 - 00:10:07:24 Tej And we're going to need to pull in clinicians to think about where it gets deployed, what part of the workflow should be addressed by technology and what should it take over. I think there's a lot of work for the industry to do. We're not good at it. We haven't been. 00:10:07:27 - 00:10:11:29 Michelle So how does Accenture then take away that hesitation? 00:10:12:02 - 00:10:35:28 Tej You know, so we're in the early innings of what GenAI is going to be able to do of where technology is going to be deployed. Truly, I think the organizations that are taking the leap forward and adopting and figuring out, you know, how technology is going to be integrated into care delivery, are taking some really basic steps. They need to have a policy on generative AI. 00:10:36:01 - 00:10:59:06 Tej They need to have governance, they need to figure out what is their data architecture and what's that foundation going to look like so that they can access that data to enable their clinicians to deliver care. They're going to need to think about on the back end how they train their clinicians and, you know, when they actually eventually do deploy technology, what is it going to look like? 00:10:59:07 - 00:11:03:26 Tej How is it going to transform the way that they work, the way that they deliver care. 00:11:03:29 - 00:11:25:28 Michelle Wow, transforming the way that we do work? When you say that, I think to myself, gee whiz, it would be marvelous. And in my mind, I would love to be able to be the ER doc seeing the cardiac chest pain patient and the intuitiveness of the system being that it understands who I am, what I do, what's going on with my patient. 00:11:26:00 - 00:11:42:25 Michelle It then brings in from the EHR what I need to know then, but then also helps me to go along with the best practice guidelines and recommendations while not forgetting that other stuff that you were speaking about before. With regard to referrals. Do you think that that's possible? 00:11:42:27 - 00:12:14:07 Tej So when I built my company, the fundamental premise that I was going for is technology should always be in the background. It should not be the reason that we get up in the morning and do anything right. It should be the enabler, it should be the assistant, it should be that third year medical student or third year resident that just enables you to do your job and perform at your peak all the time and think somewhere along the way, you know, we didn't sort of catch on to that. 00:12:14:09 - 00:12:29:12 Tej And I do think that with generative AI that we have the potential to drive that type of experience for clinicians who really are customers and clients of health systems. And we need to start thinking about them that way. 00:12:29:15 - 00:12:52:13 Michelle So I have two questions on that. We also spoke about the P word productivity. And as physicians, especially ER, we know that that can be something of a double-edged sword. So a lot of us want to frame it, couch it, present it more so as efficiency and effectiveness. How do we bring that message across with trust? 00:12:52:13 - 00:12:54:22 Michelle Because there is trust to be rebuilt. 00:12:54:24 - 00:13:20:08 Tej Yeah, you know, it's a great question. I agree that it's a double-edged sword. I think, you know, we productivity is what the organization cares about, but it's not necessarily what a clinician cares about. You know, their schedules are full, they're overloaded already. They're seeing more patients than they want to, and they're stretched way beyond, you know, the schedules that they're supposed to be working. 00:13:20:10 - 00:13:40:09 Tej And it's a lot a large part of why we're seeing the burnout that we're seeing amongst clinicians today. And so I think as we again, as part of how we think about technology and where it gets deployed and how it gets deployed, we have to bring the clinician along. And I think we have to think about what are the messages that are going to resonate. 00:13:40:09 - 00:14:04:12 Tej Just like when you do any sort of change program at any organization, they care about taking care of that patient and how do we articulate it to them that this technology is going to enable that, that this technology is going to power the experience that they want? Again, going back to this idea of the clinician as a customer or a client of a hospital system. 00:14:04:19 - 00:14:27:22 Tej Right. Because 75% of clinicians are employed now. Right. And if we think about them as customers that are, you know, they're producing the outputs that we want, which is units of care, we've got to figure out what resonates with them, what makes them tick, what's going to get them up in the morning and help them use the technologies that we're going to make available. 00:14:27:24 - 00:14:33:28 Michelle What's going to get them back at the table to actually have that conversation right, Because they need to be there. We need to be there. 00:14:33:28 - 00:14:36:07 Michelle So going back to burnout, burnout is not new. 00:14:36:07 - 00:14:52:20 Michelle And the question I have for you there is with regard to burnout and AI, do you think that there is meaningful use in there that we can honestly really tackle that meaningfully and impactfully? 00:14:52:23 - 00:15:00:25 Michelle Or do you believe it's going to take a long time, like decades worth of time to get there? Big questions. 00:15:00:25 - 00:15:24:22 Tej Yeah. And you know what, Michel? I'm not sure I have the perfect answer to it. I think what I'd say is we have to try. I think this technology has the promise to change how we practice, to create the space for us to do the thing that we had intended to do and take away all of that distraction. 00:15:24:25 - 00:15:58:27 Tej But I think we also need to think about ways that the technology can change the roles that we play as clinicians right. And you know, how it can augment us in different ways or automate some of the work that we're doing. And that's going to require real analysis of workflows. It's going to require real, you know, work and effort to rethink and rejigger the jobs for clinicians as a whole. 00:15:59:00 - 00:16:05:22 Michelle So there's a receptiveness there to an acceptance there that we are going to have to change. And we're not known for being change agents now, 00:16:05:22 - 00:16:31:23 Tej There's a lot of fear. I think there's,I want to keep doing things the way that I've done them, but I know that what I've been doing is not working and I think it's  going to be a very tricky sort of journey for health systems and for us as we work with them to help them navigate it, because every system is going to be different and you know, it's going to depend on the culture. 00:16:31:23 - 00:16:53:09 Tej But I think we need to get to and this will take a little bit of time is for clinicians to start having the culture of being accepting of change because you know it, I know it. I think everyone that's going to be listening to this knows that this is not the end. This is really the beginning of real transformation. 00:16:53:11 - 00:17:10:01 Tej And the change is going to come fast and furious. And what we need to do is prepare our clinicians and organizations to know and expect that and help them understand how to navigate that. And I think that's going to be a long and durable journey. 00:17:10:04 - 00:17:12:10 Michelle It will be. And you say fear. 00:17:12:10 - 00:17:30:08 Michelle how do we start working to allay some of those fears and trying to get to the point of balancing out even just being straight up facing Gen AI as a functionality that has so much opportunity and then proceeding to that lean in, how do we help people to do that? 00:17:30:10 - 00:17:34:02 Tej I think we're never going to take humanity out of health care. 00:17:34:02 - 00:17:43:12 Tej Health care is about, you know, the clinician and the patient in that relationship and navigating the health and staying and remaining healthy. 00:17:43:12 - 00:17:52:10 Te In the short term and in the medium term, we're in this transition phase from technology being librarian to an advisor. 00:17:52:14 - 00:18:20:17 Tej And it's going to be an advisor for a very long time. That transition to agent is going to happen, you know, very quickly on administrative work, but it won't become an agent on the clinical side because I think we still need to use our judgment. That's what we were trained for. We know what's right for that patient and getting that advice, getting that support being augmented by technology is not outside the realm of what should be possible today. 00:18:20:22 - 00:18:30:02 Tej It's available right now, but that role is going to need to change. Right. What we do every day will change and will shift. 00:18:30:04 - 00:18:55:15 Michelle I love, though, the vision of returning to being that empathetic partner who helps to guide the patient through this journey back to health or to maintaining wellness, that would be phenomenal as opposed to always having people fall into gaps and into holes. And with that, let's talk a little bit about what GenAI may or may not be able to do with regard to access and health equity. 00:18:55:17 - 00:18:57:07 Michelle Let's  talk a little bit about that. 00:18:57:07 - 00:19:25:08 Tej Yeah, You know, the shortage of clinicians that we're seeing around the world, it's not just the U.S., right. The projection is 10 million shortage over the next decade. And that disproportionately affects patients who don't have the means to access care. As an emergency medicine doctor, you appreciate the number of patients that come in as a site of last resort because they have no place else to go. 00:19:25:11 - 00:19:52:20 Tej It actually is not very convenient because the wait times are just getting longer and longer. And so what we're seeing is the disproportionate impact of the clinician shortage on populations that, you know, have not historically had. The means to access care. And so what I think and what I believe is with technology, as we scale capacity and we retrain clinicians on what their role is going to be, we're going to create access. 00:19:52:20 - 00:20:03:28 Tej We're going to start to address the health equity challenges and barriers and inequities, really that that we see as a society, not just in the U.S., but everywhere. 00:20:04:00 - 00:20:06:05 Michelle Beautiful, beautiful. 00:20:06:05 - 00:20:25:16 Michelle How do we introduce GenAI to patients and have them accept that sometimes they're not going to be able to talk to the nurse and ask the nurse when the pharmacy is open and understand why that's important and how this technology is also intended to serve them and to help them to do better. 00:20:25:16 - 00:20:43:19 Tej there's really two things that are really important related to AI and how we make it available to patients. One is around having, you know, a framework around responsible AI. And when we make the technology available to patients and for what use cases, because you're not going to it's not general availability for everyone. 00:20:43:21 - 00:21:01:28 Tej And then the second thing is, you know, we have to understand how we segment the patients that we serve, because your 91-year-old aunt may never want to interact with technology in the way that I do or that a 25 year old does. And I think we have to respect that and we have to appreciate it. 00:21:02:00 - 00:21:32:17 Michelle So we've hit now patient, we've hit provider, let's hit the hospital organization. They’re the decision makers ultimately as to what comes in, what gets implemented, what gets discarded or what what's put on by the backlog or the back burner or how do you see the conversation going with hospital decision makers about going forward with a roadmap that includes AI? 00:21:32:17 - 00:21:49:03 Michelle Because a lot of the discussions that I'm having are we want to see somebody else dip their toe in, we want to see somebody else dive in and survive. How do you see that conversation going or how would maybe you approach that conversation with someone who is a bit hesitant and wants to stand back a little bit longer? 00:21:49:03 - 00:22:09:01 Tej the truth is there is not a choice that health systems are going to have to make the investment in AI and GenAI, because we're all facing, you know, really critical workforce shortages. And we need to create capacity right now and we're going to need to do it in a durable, you know, long term way. 00:22:09:04 - 00:22:29:19 Tej The truth is there's a billion different applications of GenAI and, you know, we don't need to explore all of them all at once. Right now. What we need to do is very simple things around the investments in AI. You know, we have to have a responsible framework and governance and a policy for how we're going to deploy it. 00:22:29:21 - 00:22:57:07 Tej What's the oversight going to look like? We need to have that technology foundation and the data foundation to make sure that we're really leveraging all the data that we have. And truly we have to think about how we train clinicians and the rest of our workforce to adopt the technology so that when we get to scale, it's going to be used, it's going to create and have the type of impact and the ROI that we want. 00:22:57:09 - 00:23:17:26 Tej I guess the last thing that I would say is right now,  GenAI touches so many different parts of a health care organization. It's not just the chief medical officer, it's not the chief nursing officer, it's not the Chief  HR Officer It's not the Chief Operating Officer. It's not the CFO, it's not the CIO, it's not the CTO. 00:23:17:28 - 00:23:43:23 Tej And really figuring out in the context of, you know, an industry wide sort of, you know, crisis around margins, right? Where margins are in the low single digits, you know, and negative for more than half of the health care systems in the U.S.. How do you make this investment in the context of where a lot of other things are burning? 00:23:43:26 - 00:23:59:11 Tej How do you prioritize it and who do you go to and who makes the decision? Who who's going to be accountable? Who's going to drive the transformation? Who's going to drive the training? Who's going to drive the change? I think health systems are trying to figure all of that out and they need help. 00:23:59:14 - 00:24:28:23 Michelle They do. They do. They're going to need a partner who's going to be able to sit with them and understand where they are. More so, though, a lot of other discussions I'm having are people want to just kind of throw air out there as the panacea and the magic wand to fix everything. And there's a real struggle to contain it and say, let's pick one goal, something that is small yet impactful, that doesn't derail the ability to do care, doesn't disrupt your whole organization. 00:24:28:25 - 00:25:00:21 Michelle And those are some of the most impactful and beautiful conversations. And then when you get it right and they have a win under their belt, maybe tomorrow, I in the way of provider satisfaction, retention, patient engagement is better. Those sorts of discussions and those sorts of wins are huge. So I think that it is incumbent upon us and our positions and others out listening to this and similar positions to be that selfless advocate slash partner to your customer and help them along this path because it is complicated. 00:25:00:21 - 00:25:16:00 Michelle Let's talk a little bit then about health care, utilizing technology to catch up with other industries, because other industries are fairly far ahead of us when it comes to tech and efficiency and productivity, using technology. 00:25:16:00 - 00:25:41:12 Tej A lot of us like to say that if you want to know what's coming next in health care, look at what happened in other industries 20 years ago. What's incredible to me is that generative AI is being contemplated and probably more advanced in health care than it is in several other industries today. And it's almost moving at pace. 00:25:41:15 - 00:26:03:14 Tej And I'm not really sure exactly why that's happening. I think that, you know, maybe it's the shortage, maybe it's the margin pressure, maybe it's the potential, maybe it's, you know, some of these thought leaders that are really expounding on its use and its application, its potential in health care. Maybe it's just the burnout that's happening amongst clinicians. 00:26:03:14 - 00:26:17:14 Tej None of my clients on the provider side can afford to wait for the perfect sort of, you know, what are all the use cases and how do I sequence them and everything that I'm going to do for as you said, for the next five or ten years? 00:26:17:17 - 00:26:52:29 Tej I think we have to start now and there's a place to start right now. There are things to do to prepare yourself for that future and I think we're going to be astounded by the creativity of the clinicians that that you and I work with and that work for these organizations on how the technology can be deployed. And I think we have to just be open to it because I think we're going to see the potential and, you know, sitting behind a desk or sitting in a lab, you know, looking at the technology and thinking of use cases, that's going to get us only so far. We have to put it in the hands of 00:26:52:29 - 00:27:04:27 Tej clinicians having the appropriate sort of governance and guardrails. But that's how we're going to learn what it can do and how it can help and how it's going to impact, you know, how we deliver care. 00:27:04:29 - 00:27:09:21 Michelle That sounds like a great call to action. ‘Come to the table, your seats waiting’. Let's do this. 00:27:09:21 - 00:27:13:05 Tej Yeah, let's do it. I mean, ER doc, right? Like, let's go. 00:27:13:12 - 00:27:30:15 Michelle I love it. I love it. Well, thanks for your time today, Tej. Thanks to our listeners. Be sure to subscribe to the Perspectives on Health and Tech podcast for more insights from industry experts, visit Oracle Dotcom Slash Health or follow Oracle Health on social media.

As society’s focus on mental health intensifies, technology stands at the forefront of this evolving narrative. Listen in as this group of experts examines technology’s paradoxical role in mental wellbeing: constant connectivity that reveals insights yet also increases burnout due to poor design, and social media, where overuse is linked to decreased mental health but provides a beacon of hope through innovation. Hear about the challenges and opportunities of using technology to enhance mental health, exploring how digital advancements can be harnessed for a healthier, more balanced future.    Featuring the following panel at SXSW Conference: Moderator: David Feinberg, M.D., Chairman, Oracle Health Danny Gladden, MBA, MSW, LCSW, Director, Behavioral Health and Social Care, Oracle Health Tracy Neal-Walden, Ph.D., Chief Clinical Officer, Cohen Veteran Network Michelle Patriquin, Ph.D., Director of Research, Associate Professor, Menninger    Listen as they discuss: The moment realized, that access to care needs to be fixed (0:40 What is happening from a technological standpoint that is helping individuals, patients, families, and communities (4:33) The use of iPads Research assistance The collection of outcomes data An example of something done based on data to change the way that care is delivered (6:20) The role of sleep Post-treatment and post-discharge risks Q15 (15-minute patient safety) checks Example of the effectiveness of telehealth (9:15) Prior and post-pandemic Impacts on standard measures Additional data insights Impact on no-show appointments Using technology to tell a fuller story (12:45) Wearable devices Digital therapeutics and inputs Research to practice gap and the potential of technology (15:38) Concerns with technology not helping or distracting from human connection (17:05) Social media and the link to depression (17:50) People who are left behind; technology access and literacy (19:00) Psychologic safety of technologies (20:00) Concerns from the clinician perspective (20:45) Helping clinicians with documentation and proper training of tools leveraging AI (21:44) Clinician burnout (22:34) Notable quotes:  “This is why I love wearables, and I’ve always loved wearables, psychophysiology, because it fills a tremendous gap in our ability to measure the dynamic fluctuations and the way our emotions and behaviors change.” Michelle Patriquin, Ph.D., Director of Research, Associate Professor, Menninger (15:10)   Learn more about how Oracle behavioral health solutions combine real-time clinical data from across each patient’s unique healthcare journey.   Watch on-demand and live webcasts by registering for Oracle Health Inside Access.   --------------------------------------------------------   Episode Transcript: 00:00:00 You're listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data and technology to help improve health for everyone. 00:00:11 David My name's David. I'm the chairman of Oracle Health. And before I introduce this esteemed panel, there's a few patients that I've cared for, and I'm a child psychiatrist that have just stuck with me. And for a lot of reasons. Well, I actually feel like for whatever long I've been in this 30 plus years, I'm just trying to make it better for these patients and their families. 00:00:34 David So let me describe them. And I think it really sets the stage for the role of technology in mental health. Okay. This little girl in third grade at the local school where my kids actually went to school writes in her haiku poem that she wants to commit suicide. And this is pre cell phone guys pre technology. The teacher reads the haiku poem and tells the prince at home that night tells the principal. 00:01:01 David The next morning, the principal then calls the mother at home. And then this is L.A. And because they knew people, they were able to get in to see me in three weeks. And I was like, my God, if my kid was suicidal, it doesn't matter who, you know, you got to be seen today, right? I didn't know this word, but I know. 00:01:22 David And now I'm going to fix access. I mean, that's what we use is this term access to me is my kid is suicidal and I'm calling an 800 number and my insurance doesn't cover it or I got to pull strings and God forbid I'm from the other side of the tracks where I don't know anyone. I will never get it like. 00:01:40 David So how can technology help there? Right now, I think what we're supposed to talk about, too, is the negative part of technology, right? I'm stuck on my phone. I'm not I'm not socializing. I'm, you know, we all go to dinner and we're like this instead of actually being together. So why don't we go down the line and introduce yourselves? 00:02:03 Michelle Okay, everybody, I'm Michel Patrick Quinn, and I'm a psychologist and a child psychologist, and I'm director of research at the Menninger Clinic and an associate professor at Baylor College of Medicine. I'm excited for this conversation. The Menninger Clinic is really known for humane treatment of mental illness. We are historic, known as an inpatient psychiatric hospital and really revolutionary and something called the therapeutic milieu. 00:02:30 Michelle And so kind of actively intervene and doing psychotherapy while someone is inpatient. So it's not a passive intervention. And it's really just remarkable. We still hold on to that kind of psychotherapy within an inpatient context. 00:02:47 Tracy I am Tracy Neal Walden. I'm a clinical health psychologist. I work for I'm the chief clinical officer for Coimbatore and Network. We're a network of mental health clinics across the US. We have clinics in 16 states covering, supporting 25 states. So and that's because of telehealth. So we utilize we don't do solely telehealth, but we've been able to utilize telehealth in order to expand our reach across the US. 00:03:18 Tracy I'm also a veteran of the United States Air Force. I served for 24 years and served as a psychologist during that time in the Air Force as well. We serve not only the veteran but the veteran's family members. As a veteran, myself, my family doesn't have access to care in the VA, and that's no fault of the VA. 00:03:37 Tracy It's the way the system is set up. And so we're able to reach and provide those resources to families and in a much shorter time period, especially due to the advances that we're going to be talking about now with technology, 00:03:53 Danny Thank you and so I'm Danny Gladden. I'm the director of behavioral health and social care for Oracle. 00:03:59 Danny Happy to be the social worker on the stage. And I really proud to work with just a whole group of social workers in the delivery of mental health services and all the great work social workers do. 00:04:11 David Today, what in your organizations is happening from a technological standpoint that you think is improving access, improving quality, democratizing care, making care more affordable, more culturally sensitive, helping with, you know, inequities that we know that are in care? What are you doing to harness technology that's actually helping individuals, patients, families, communities? Sorry, go for it. 00:04:34 Michelle Yeah. So it's not really revolutionary in any way, but we use iPads and research assistants and collect outcomes data across our whole hospital and with inpatients in outpatients, outpatients, it's pretty standard. People are able to complete, you know, outcomes, measure, self-report, inpatient. It gets more complicated. And we have to we have to guide people, help people. Some good times, people resist, don't want to do it, and that's fine. 00:05:00 Michelle They don't do it. But that to me is the foundation, right? So if you collect outcomes data that gives people a voice in their treatment, particularly on inpatient. So our inpatient units are locked units, you have reduced someone's on autonomy when you measure how they're doing, from their perspective, it gives them some control back. And I think that is one of the most powerful things that we can do is give people control back through data and measuring these things and measuring the change over time. 00:05:32 Michelle Whether it's positive or negative. And technology allows us to do that. So many of our patients want to use the iPad, and then we visualized the data in graphs that are provided to the treatment team through our electronic health record. And so that gives data driven feedback that the treatment teams can actually provide to the patients at the patient level. 00:05:50 Michelle We also use it for research to understand like aggregate results, what's working for who and what's not. But I think, you know, I'm biased, I'm director of research, so I love data. I'm the PI over our outcomes. But I think that's tremendous. And we can advocate for better inpatient environments, better inpatient care, better inpatient outcome. 00:06:12 David Can you? I think it's a great example. First of all, the simplicity of it is sometimes to make things simple. It's really hard and so this is great. Can you give an example of something you've done based on the data to change how care is delivered? 00:06:23 Michelle Yes. So well, something we're working on right now, all of our results are lining up really around the role of sleep. One thing we are constantly thinking about is suicide risk with inpatient, and particularly suicide risk post-discharge for those of you who may not know post-discharge from inpatient is the highest risk period for suicide. Over and above any other time in someone's life and also relapse. 00:06:52 Michelle So post in our highest level of care. And to us that is incredibly concerning. So we have been really thinking about the role of sleep as well as other measures and look at longitudinally outcomes while someone's inpatient what is predicting suicide risk and we have a paper that we published, we showed it is sleep over and above everything else that you can put in the model. 00:07:16 David And you measure using our rings and things like that or how are you. 00:07:18 Michelle Not yet. We are now because it is so important and we've now designed our own like API and with wearables to replace things that we do in inpatient that actually disrupt sleep. So like you, 15 checks and these checks. So there's checks done on inpatient to ensure someone's safety and sound checks. And these are often pretty disruptive. We have data now from active Griffey that we've lined up with the checks in about 75% of those checks. 00:07:48 Michelle So someone going in their room, usually a stranger that they do not know, opens the door, sometimes shines a flashlight in their face to make sure that they're breathing and that they're asleep. Or if they're not asleep, they'll ask them to raise their hand. And so and for us at our hospital, it's every 15 minutes that happens. That equals about 36 times a night. 00:08:06 Michelle Someone comes in their room. So we've designed our own kind of in-house homegrown system to replace that. And that is one and it's just one thing that, like we always say, you know, when technology is, you know, going to take over and ruin people's privacy, things like that. But in that situation, it improves people's privacy. People can sleep and be and have intact sleep. 00:08:29 Michelle Great. So it's that and that has just that's one of our favorite examples. Right. Just kind of generic outcomes data into a new intervention that leverages technology that improves some of these outcomes. Hopefully in the end we're still working on it, but so cool. 00:08:46 Tracy Yeah. I think it's really interesting what Michelle just discussed in terms of outcomes because we do measurement based care for all of our clients. So we measure their, their symptoms at every session and we do that via iPad. If they come into the clinic or we push it out electronically for those who are being seen for via telehealth. 00:09:10 Tracy And one thing that we found is that we actually we want to take a look at how effective is telehealth, because many people say it's not effective. You know, prior to the pandemic, people were very skeptical. And we actually use this data and we have a research institute that's part of our and veterans network. And within the institute, they reviewed the data recently and we found clinically significant change in Q nine scores is for depressed individuals and for those with PTSD, a clinically significant change in their PCL. 00:09:50 Tracy So these are the measures that are the standard measures given for those populations. And not only did we find clinically significant change, but we also found that those individuals were in remission. That's one of the things that I love about technology. It allows us to get those additional data insights. We rolled out telehealth in 2018, so before the pandemic, and we did it to improve access and not just access due to long wait, but to decrease no shows in to improve that accessibility for clients who were already in care. 00:10:29 Tracy I remember a few years ago I had a client and we would advertise in our clinic. We had rolling slides that would tell about the different things that we offered, and we had a slide that talked about telehealth and it said, Ask your clinician if you'd like to know more about it. And my client came in that day and said, Hey, would I be a candidate for telehealth because I fall asleep on the drive home from here and I was like, Yes, you being silly. 00:10:59 Tracy And that's also the beauty of telehealth, because it also it allows you to oftentimes squeeze additional appointments in if someone knows shows and it helps to prevent no shows, too, because oftentimes some people like to come in, they will they like to come in and see their clinician face to face, which is great. But sometimes life gets in the way. 00:11:23 Tracy And so if someone calls to say, hey, I'm going to be late, then we say, Would you like to convert that to a telehealth appointment so that they don't have to miss that appointment? 00:11:34 David Okay, Danny, take us home on that wonders of technology. Yeah. Then we're going to flip it. 00:11:39 Danny We're going to flip it. Okay, Well, so. So for Oracle, we build tools. We build tools to ensure that the work that providers are doing with consumers of care have what they need to sort of ensure that that, you know, the clinical experience checks the box so that, you know, the 15 minute check that Michelle was mentioning is something that happens in our tools and the screening and the screening that happens in our tools. 00:12:05 Danny We've embedded in the workflow for nurses, for oncologists, for the ED attending. We've embedded in the workflow a suicide screening tools and, and then and then alerts so that if someone is at risk, it's not just one person who's aware, but the entire treatment team can have this ability face up to this type of information. And so we sort of want to help folks use digital tools to be able to track patient information, to be able to get folks get folks in quicker. 00:12:37 Danny But I think beyond that, the beauty of technology in general is there's an opportunity to tell a fuller story, you know, through wearables, through some of the cognitive behavioral interventions, the digital therapeutics. It just really provides a variety of different types of modalities for consumers of care to be able to sort of deliver inputs about their experience. 00:13:02 Danny You know, if I have to get in the car, drive to a clinic to see Michelle in person, I'm putting on a mask. And all you really know about this individual is probably what happened an hour or two before they got to you. Like it's the stress of the moment using wearables, using sort of digital inputs throughout the week in between sessions, I'm able to I'm able to sort of have a more holistic picture of what your week looked like. 00:13:31 Danny And because you're doing the session in your own home, you don't have to put on a mask. It is more intimate. And I'm able to, as the provider, just have a more holistic picture of what I'm working with. Okay.  00:13:45 Tracy Can I add one more thing? 00:13:46 David You could add ten more things. 00:13:47 Tracy It gives you more accurate information. You know, as I was thinking about what you were saying, Danny, about the technology and you, Michelle, when you were talking about sleep, sleep is one of the number one concerns within mental health. People may come in with issues such as depression, anxiety, PTSD, but there's usually an underlying sleep problem. And as a health psychologist, I love to treat sleep, but clients history directly underrepresented the amount of sleep that they actually get. 00:14:19 Tracy And by using something like a wearable, a watch or a ring, you get that accurate data that then you can immediately share with them or they can see it immediately themselves. 00:14:32 Michelle I completely, completely agree with Tracy and Danny, and I think the beauty of the data when we talk about outcomes data, self-reported data, those data are collected, you know, every week. So you have huge gaps in the information that you are getting about somebody's experience. You know, our emotions can change within seconds. You know, there's a you know, can be a traumatic event happen or just a, you know, an argument with someone. 00:15:01 Michelle So our lives and our emotions behaviors are very dynamic and our outcome measures and the data that we have now is why I love wearables. And I've always loved wearables, psycho physiology, because it fills a tremendous gap in our ability to measure the dynamic fluctuations and the way our emotions and behaviors change. That is so important, I think, for understanding the ultimate outcome and just that that the kind of higher temporal resolution of the data is something we don't have now in practice. 00:15:36 Michelle There's such a research to practice gap there that I think technology will certainly fill in and also has the potential. And one reason I love the wearables, because it really demonstrates that it's not all in your head. Yes, too, when you do a self report, that is your perception, right, of how you feel in and with the wearables, too, it gives an objective marker for the first time in vivo in the situation to show, Hey, I'm really experiencing this, this is real, this is how I'm inside. 00:16:11 Danny Yeah. And I think about this just real quick. Like in our. 00:16:14 David Now we’re cooking. 00:16:14 Danny Yeah, I mean, well, in our discipline historically, you know, we don't we don't get access to labs, We don't get access to some, you know, some good radiology scan. We find out something about someone by asking a bunch of really nosy and intrusive questions by observation or someone has sort of engaged, you know, has had a crisis in their, you know, the courts or corrections or a probation and it is point in time, like, how many times do you start a session where, you know, how have you been since I saw you,fine, right. 00:16:49 Danny I mean, and that's sort of the starting point. So the ability to have real time inputs, the seven or the 14 days in between the times of seeing each other it just enriches the clinical experience so much. 00:17:03 David We're flipping gears. What are your concerns around tech not helping us, tech distracting us from human connection? 00:17:14 Danny I'll start us here. And so, you know, I, I still see I still see a few clients from time to time. I particularly enjoy working with adolescents and sort of the narrative from adolescence in the stories they sort of come up with in their mind about the world around them is really quite distorted, you know, based on the stories they get from social media. 00:17:40 Danny And I'm not talking about sort of what fake news, which is its own lane, but sort of the attitude that, you know, folks around me are just having a much better experience than I am. And what we all know is that there's likely all of it is inflated a little bit or a lot of it. 00:17:59 Danny Right. And so we know this. We know that the data on sort of overuse of social media and the link to depression and anxiety in young people is real. What we are seeing, though, is that transition, you know, it's not. So if I'm down, I'm feeling bad about myself. I'm now starting to engage in, you know, in ways to numb that pain. 00:18:25 Danny And that's, you know, through self-harm, through self-injury. It's, you know, through alcohol use or other substances or it's sort of engaging in relationships that are unhealthy. So I'm really I'm from the adolescents that I get to work with. I'm really concerned about that. On the other side, the part that concerns me about tech is, is I mean, we've just sat here and talked about all of the benefits that technology can bring, the access, the data, physio, bio physiology data. 00:18:55 Danny But the problem is there are people left behind, there are people left behind in the in the most remote parts of Alaska. There are there are folks that are left behind within a, you know, a mile radius around here. And so, you know, we have to ensure that that the tools that are created impact and benefit all of the people. 00:19:19 Danny And you know, so I think tech access, tech literacy, all are concerning to me as so much of our particular discipline moves into the tech space. 00:19:30 Michelle I'll kind of jump off from there. You know, I think when, you know, I'm not in the tech space, but I love technology. But I think technology does such a good job with some of these data privacy issues, and they do a lot in terms of the technicalities of how things are going to work with the interface. Looks like is are there protections in place, right, that safety is built in? 00:19:54 Michelle I think one thing that is forgotten, though, and, you know, I don't know if we even knew that was going to be a consequence is no one was testing the psychological safety of these technologies, especially when it comes to social media. Right. As we, you know, are kind of zooming forward with technology. There's all these, you know, kind of ethical safety guidelines, American Psychological Association. 00:20:18 Michelle These are really good job at starting to think about the psychological safety. What are the psychological kind of safety parameters that we need to test as we develop new technologies? But also then how do we put the guardrails up on the things that are here now? 00:20:35 David Tell me other things that concern you about technology and mental health. 00:20:39 Tracy I actually have another thing, and I'm going to shift it a little bit. I get concerned from the clinician perspective because we've technology has really helped us. We instead of, you know, giving a and I remember when we gave out the paper and pencil measures to our clients when they came in to the door, you had to wait for them to finish it. 00:21:01 Tracy But the good thing about that is when they did, then I immediately had it. I reviewed the scores. Now measures are sent to us, you know, automatically, and then they go into our system. And so you really have to train the clinicians to utilize that data and not just have the client submit their data without it being utilized. 00:21:29 Tracy Someone could submit data that could indicate that their risk status has changed. And if it's not being looked at, that's a huge concern. We're also looking at ways to help clinicians with documentation. However, a concern that I have with that too, is that, you know, if you're using AI to do your documentation, there could potentially be errors. And so we have to train our clinicians to properly utilize these wonderful technologies so that they can use them effectively. 00:22:03 David Yeah, we're working really hard on that. I think we've got good stuff coming out. 00:22:08 Danny Well, yeah, and, and actually so big because we don't have labs and radiology scan to sort of show a paper. Here's the evidence for the diagnosis. Our word, our discipline is very narrative rich. And you know, just to be able to sort of either get a prior authorization for service or to be able to continue service. And so we have a clinician burnout issue because of the administrative burden, the documentation burden. 00:22:36 Danny And, you know, so that's and the tech just facilitates that. But I do think is exciting, you know, ambient genitive AI and ambient for documentation. Our little our slice of the pie has been carved out and I'm so excited. And, you know, so Microsoft has gone there's some other startups out there that got Oracle's working on its tool that will really shift the burden away from documentation. 00:23:04 Danny I think it's going to be a game changer. 00:23:06 David Great gratitude to all of you folks, and thank you for participating. Thank you. 00:23:11 Be sure to subscribe to Perspectives on Health and Tech podcast for more insights from industry experts, visit Oracle dot com slash Health or follow Oracle Health on social media.    

Four women health care leaders discuss the value of connected health data, clinical studies at the point of care, neurodiversity considerations in data collection, and the importance of community care. This second episode on women’s health continues the conversation on how health systems need to change to eliminate barriers and address the needs of women patients to provide whole-person care.  Featuring: Moderator: Nasim Afsar M.D., MBA, chief health officer, Oracle Health Christy Dueck, Ph.D., global head of the Learning Health Network and Health System Activation, Oracle Health Esther Gathogo, M. Pharm., Ph.D., senior performance improvement leader, Oracle Health Sarah Matt, M.D., MBA, vice president, physician and healthcare technology executive, Oracle Health Listen as they discuss: Many women prioritize others’ care above their own needs. What are ways technology can partner with providers to ease this burden? (2:49) Clinical trials Patient engagement and automation When patients feel like they aren’t being listened to, they might seek alternate options. How can patients and clinicians work better together to make sure they're bringing all of the data and modes of health and wellness together to really treat the whole person? (8:53) Providers need to re-educate on other modalities Patient education  Social determinants of health data in the EHR  How can we bring data together to proactively help communities that are exposed to higher risks? (12:43) Using data to identify populations preventatively Digital therapeutics What are some other ways you’ve seen health organizations share info with their communities? (19:56) “I think that it's really about how can we make these super busy people utilize the tools that work for them best … Because every data element I don't fill out as a patient is a data element a medical assistant, a nurse, a doctor is going to have to do instead, which means less time treating me like a patient.” – Dr. Sarah Matt  “Where you live has a tremendous impact on your health and well-being, not just at a country or state level, but down to the neighborhood level. And so when we can get that information in the EHR, then we're able to proactively engage based on transportation barriers, food insecurities.” – Christy Dueck, Ph.D. “How do we pull that data together to be able to proactively reach into those communities? When I think about women and historically vulnerable populations, I think those are some of the same type of thinking and methodology that we have to leverage in connecting the data together, using data from a variety of sources to proactively identify populations, and then reach out to them.” – Dr. Nasim Afsar “There are a lot of [technology] platforms I feel that have come on board, which just makes it more accessible for people. And then just thinking about different groups of people who may perhaps were not considered before, like neurodiverse, and are we thinking about them when we are designing the [technology] systems or thinking about their data and how to connect their data … How do they communicate with their healthcare provider? Do we have a lot of information about that? Neurodiversity covers quite a lot and there will be a lot of changes [to technological solutions] in terms of how we capture the information in a standardized way.” – Esther Gathogo, M.Pharm., Ph.D.  --------------------------------------------------------   Episode Transcript:   00:00:00 You're listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data and technology to help improve health for everyone.  In the second episode on Women's Health Equity, we'll be talking about how the role many women play as caregivers can present a challenge for patient engagement. We'll talk about technology and patient data and how we can effectively unify our knowledge together to treat the whole person. 00:00:37 Hi, I'm Dr. Nasim Afsar, chief health officer at Oracle Health. And joining me today on the podcast are three of my colleagues from around the world. I'll ask them to introduce themselves and give a brief overview of what they do. 00:00:53 Sarah Matt Thanks, Nasim. I'm Dr. Sarah Matt. I'm a surgeon by training my fellowships and burns, but I've been in product development all over the world for my entire career. That's building our electronic medical records, new mobile applications, patient engagement solutions, you name it. First, I came in to drive our OCI, the cloud side of our business for health care and life sciences. And now, after our acquisition of Cerner, I focus on new product development.  Nasim Afsar Thank you. Esther?  00:01:20 Esther Gathogo  Hi, I'm Dr. Esther Gathogo, and I'm a pharmacist with 18 years’ experience working across different sectors: community, hospital, academia and clinical research. And I currently work as a senior performance improvement leader in international based in UK. And I also focus on health equity and AI. 00:01:40 Nasim Christy? Christy Dueck Hi, everyone, I’m Dr. Christy Dueck. I'm the vice president and global head of our Learning Health Network and really have responsibilities around creating health system partnerships with life sciences industries to bring clinical research as an integrated component of clinical care.  00:02:02 Nasim Thank you, Christy. And my background is in internal medicine. I practiced as a hospitalist for over a decade in tertiary, quarternary academic medical centers. I've been in health care administration on the health care delivery side for over sixteen years in roles, in quality roles, in health management, contracting and health care operations. My team is focused on how do we ensure that across the globe we have healthy people, healthy workforce and healthy businesses. Driving the best of products and services to ensure that we're improving the health of the world. So thrilled to be here and thank you all for joining me today as we talk about women and health equity.  00:02:49 Nasim Afsar Many women prioritize the care of other people, their loved ones or family members above their own, and oftentimes may feel like they don't have time to take care of themselves or be able to do the extra research that's required or seek a second opinion. Some of the ways that technology can help partner with providers to ease that burden. Christy, what do you think about this? 00;03;17 Christy Dueck Well, I'm going to hit it from that clinical trial perspective again, as we look at ped's trials. We know the number one driver of not enrolling enough kids onto those trials is because the appointments happen when parents are working. And really when moms are working. And so it's, again, something as simple as we're changing that behavior so that we can bring that clinical trial out of a clinical research organization or at a specialty clinic that's 4 hours away from where that kid lives, and actually make it available at the point of care within their community on a Saturday morning so that a mom can take her kid to be part of that trial. 00:04:00 And instead of trying to create processes where we're enabling health systems and caregivers to work at optimum times, we've got to also create processes that actually allow our community members to engage in the care that they need on the time systems that work for them.  And so I think, Nasim, you know, exactly what you were saying is that if we're going to have moms engage in their own health and in the health of their kids, we've got to make it available for them at a time that works for them. And it can be something as simple as changing those appointment times, or the availability for them, that completely changes the outcome of a clinical trial.  00:04:42 Nasim Sarah, wondering about your thoughts on this.  Sarah Matt So for me it's really about options. So I'm here at my desk and on my desk I have this letter. They actually send me a letter from the doctor's office and it was about an upcoming appointment. First of all, I'm in a generation that a letter is just not going to work. It's not going to cut it. But I was never given the opportunity to tell them how I communicate best. So if they would give me an option to use some other patient engagement tool, a portal email, a text message, literally anything else for me would be a better option. 00:05:20 But I think that's the trick, is that technology can allow for more options. So maybe Christy is a text person. Maybe Esther actually will listen to her phone messages. If someone calls me, they're never going to get a hold of me. But, you know, I think that it's really about how can we make these super busy people utilize the tools that work for them best. And every health care organization uses patient engagement tools, whether they're using a third party for a kiosk in their office or a patient portal or other outreach mechanisms for population health. There's so many ways they can do this, and some populations are going to love that letter. Other populations, like me: please text me, please send me an email, because anything I can do by multitasking, anything I can do where I don't have to stay on hold and talk to an actual person is going to be better for me. 00:06:11 I think the second piece is really about the information in your medical record. Nothing is more frustrating than showing up to a doctor's office or for me with this letter, they sent me a whole packet of papers to fill out to bring with me to my appointment on paper. I know they're going to scan that. I know none of it will be discreet, structured information, which pains me because I know I'm going to have to fill it out again. But if we can find ways to take a patient's record, to use it well, to send it to the next provider, to use HIEs, to use other mechanisms of interoperability well, then those patients don't have to get to the appointment or they don't have to worry about the information being they don't have to check it again and again. 00:06:54 Every time you write this information down, there's a chance I'm going to mess it up again. And I'm a highly educated patient. For patients that are really iffy about their health care, it can be even harder. I know for me, as I say, I have a ton of kids. When I am filling out paperwork for my four kids, I can barely remember all their birthdays. You can tell it's going to be a mess. So any time that all that information can be instead sent to me to review and verify, I'm going to do a ton better than what I'm starting from scratch. And I'm probably not the only patient out there that's experiencing the same thing.  So for me, when I think about how technology can really help patients and that patient provider burden, it's about being able to transport and use interoperability in a really robust fashion to make sure my records go from place to place and then give patients options. 00;07:50 Because every data element I don't fill out as a patient is a data element a medical assistant, a nurse, a doctor is going to have to do instead, which means less time treating me like a patient.  00:08:02 Nasim Sarah, I can promise you that you are not alone. And I look at the crazy amount of health care paper that lands in my mailbox. You know, your comment about options and preferences is ultimately an angle of precision medicine, right? It's getting health care the way that you want it, and you need it to be able to care for yourself. And I think we have we have a lot of work to do, too, to actually be able to get there.  00:08:34 When patients feel like the medical establishment is no longer listening to them, they sometimes turn to alternative therapies. How can patients and clinicians work better together to make sure they're bringing all of the data and modes of health and wellness together to really treat the whole person?  00:08:53 Sarah Matt So when I think about brining, health, medical, wellness all together, I think that in the past, and even today, we often keep them in silos. So medicine is this and there's a big fence post around it and we don't think about what does that mean to the patient. What is wellness, what is mental health? What are these other areas of health and wellness that are not necessarily part of our electronic medical record or as a part of our normal scope of practice. So first, I think providers need to really think past their training, and that's hard. As a provider who is trained in the United States, I was trained to take care of patients in a pretty specific way. 00:09:35 Fortunately, I'm from the generation that's worked on paper and electronically, so I've seen the full gamut of craziness when it comes to how to take care of patients digitally and not. But how does that intersect with chiropractic care or traditional medicine for different cultures or herbal supplement 27? Whatever it is. I think that as medical professionals, sometimes we know what our scope of practice is, and we know what we know really well. But when it comes to a new modality of care, whether it's a nontraditional type of therapy or a new medication, that is maybe not an FDA regulated medication, maybe it's something that's herbal, we don't know what to do with that. And a lot of providers, I think, often will put up that wall and say that's not a good idea. 00:10:26 That sounds kind of crazy. Maybe you shouldn't do that. But I think that if we look to ten years ago, 20 years ago, 30 years ago, that's how we thought about a lot of things. Chiropractic medicine is a good example. Some providers are really excited about it, some aren't. But time and time again, all literature will show that for some patients it decreases pain. So as a provider, should I prescribe chiropractic care? Ah, maybe not, but there's no denying that for some patients it's decreasing pain, and that's real. So what I'd suggest is first, sometimes as providers, we need to educate ourselves in some other modalities of care. Sometimes we need to recognize when some therapies are helping our patients, whether we agree or not, with the medical validity of it. 00:11:15 And we can help our patients understand what risks might actually be able. Will this medication actually do something in a negative? It’s helping this patient with pain, with depression, with this new thing. Is it going to cause harm in other ways? How can we help our patients do a risk analysis for themselves?  And when it comes to mental health, again, a lot of providers, me included, we have our scope of practice that we feel really comfortable with, and then we tend to refer out for everything else. Which is not a bad way to practice medicine, but I think it prevents us from thinking about what are those important and engaging human questions that we should be asking during our encounter. Again, what are those personable things that we can do to show that we care and to help make sure that our patient gets to the right place next? Whether it's understanding a little bit about their life, about their struggles, about how things are going in their lives, I think that's important. 00:12:15 We often are concerned about how healthy they are or are they taking their medications the way they're supposed to. But I think we forget sometimes and rarely ask, how are you as a person? Because whether they hit those marks on the depression screen scale that my nurses give them, I think a lot can be said about when they speak to me in the office, if I'm concerned about them as a human being, and then I can help get them to the right resource or help give them some information that will help them on their journey better.  00:12:48 Nasim There’s such tremendous value, Sarah, in truly listening, understanding and empowering people to be able to take care of themselves. And then for us to having truly understood them, to help them in a different way. I really appreciate that perspective. Christy, I'm wondering about your thoughts on about how can we help patients and clinicians do better in bringing all of the data together?  00:13:14 Christy  I think it's a couple of things. I think that as I was listening to Sarah, I thought of, you know, there's the social determinants of health aspect and then there's certainly the prevention aspect, where we're not just focused on treatment of a known issue, but prevention of issues presenting in the first place. From that social determinants of health perspective, you know, we know that beyond clinical data, there's so much more that impacts your health and well-being. 00:13:43 Where you live has a tremendous impact on your health and well-being, not just at a country or state level, but down to the neighborhood level. And so when we can get that information in the EHR, then we're able to proactively engage based on transportation barriers, food insecurities.  00:14:06 Nasim You know, Christy, one of the things that we talked about was how our various data on patients are in lots of different places. So that even if you have data with one EHR company and you see another health care delivery system that has the exact same EHR, those two parts actually don’t speak with each other. And so when it comes to some very basic elements of care like colorectal cancer screening, we don't really have a good sense of what percentage of the population have been screened because we have data in all these different systems that don't really come together. 00:14:50 And really the strength of, and the privilege and the responsibility of, being part of a large data company that knows data and connectivity to look at how do we solve these problems, how do we really need a system where we can have a national, and then in every country across the globe, a way to be able to pull this data together, understand it? And then there's another side of this where more data can be leveraged. Which is pulling data from lots of different sources and connecting it enables us to understand particular communities where there are, for example, food deserts: where we know patients are likely eating large amounts of highly processed foods, where the rates of alcohol consumption and smoking are much higher and those are going to be populations that are more predisposed for colorectal cancer. 00:15:49 How do we pull that data together to be able to proactively reach into those communities? And again, when I think about women and historically vulnerable populations, I think those are some of the same type of thinking and methodology that we have to leverage in connecting the data together, using data from a variety of sources to proactively identify populations, and then reach out to them. 00:16:14 Esther Just picking up on what I guess you've all said, but also what Sarah mentioned on the mental health, it made me think about digital therapeutics, an area which is growing. And even in Europe you have some countries like Germany who are now having like digital therapeutics on prescription as an alternative to giving medicine.  So I'm just imagining now in terms of how to connect some of this data from these newer applications where they've really started to show really good benefits when it comes to managing depression. And mental health is an area that I feel over the pandemic really changed the model of care and delivery and with a lot more people feeling comfortable to have their therapy virtually. And so there's a lot platforms I feel, that have come on board in which just makes it more accessible for people. And then just thinking about different groups of people who may perhaps were not considered before, like in terms of thinking about neurodiversity and are we thinking about them and when we are designing the systems or thinking about the data and how to connect the data. 00:17:36 So if you think about someone with autism or a woman with autism and how do they describe or how do they experience, for example, I'm going to talk about menstrual cycle because I started with that, but how do they experience the menstrual cycle? How do they communicate that with a health care provider? And do we know a lot of information about that? So in thinking, just because neurodiversity covers quite a lot and I think there will be changes, I think, over more incoming years, in terms of how we capture the information in a standardized way. Because then you can be able to connect the information across to be able to do research in certain groups. So I think it's quite an exciting point to be in, I guess this is this is like the pioneering stage of everything. 00:18:35 And just thinking about like we saw statistics in the UK, we have now reached 99% of households with Internet and there's more people even over the age of like 80 who've got mobile phones and they're learning to use smartphones. So I think and if you look at the smartphone and the way there's a lot of health apps on there—I think when you're talking about this whole trying to improve the physician and patient kind of relationship, this thinking about when I go home and I've been diagnosed with a condition and how to been instructed and how to manage it, how do I, what's my self-care looking like? So when I go home and I download an app that's capturing information, it might improve on the follow-up care in terms of how you capture the information and share it with the physician in your next visit. And I think a lot of that is going to become more and more easier in terms of sharing information between systems so that you can be able to improve on just seeing that holistic view of your patient across. So I think it's quite exciting. 00:19:56 Nasim Yeah, I think that's that's a great point. What are some other innovative ways you've seen health organizations share information with their communities?  Esther Yeah, So we saw just over the pandemic an increase in social media use, particularly in low to middle income countries just looking for answers really to understanding like COVID and also the vaccine itself. So we've seen an increase and they saw it as a potential tool to access hard to reach communities in terms of educating people in low resource settings on health care. And one of the things, for example, we had and within ECF last year there was Dr. Khyati Bakhai who delivered a talk on this where she was saying that she translated some information around the COVID vaccine to another Indian dialect, and that increased the uptake of the COVID vaccine within that community. So you're starting to see how social media platforms, particularly if there's a really high usage of it, particularly in low resource settings, as another avenue to reach out to those communities, just to help them on understanding more about their health and also sharing credible health information through those platforms. And also just thinking about how you can use it as well and in terms of thinking how to reach out to them if it was, for example, for research or for understanding more around even like barriers to health care for them or understanding their needs.  00:21:56 Nasim Well, thank you all for joining us for the thought-provoking conversation about women and health equity. I want to thank our panelists Christy Dueck, Sarah Matt and Esther Gathogo. Great conversation around the role of technology and how can we address some of these shortcomings and limitations that we have for women to receive better care. But lots of areas identified where we really need to work together in partnership to address as we move forward. Looking forward to ongoing dialog around this, and more importantly, action around how we can impact better health for women across the globe. Thank you.  Be sure to subscribe to Perspectives on Health and Tech podcast for more insights from industry experts, visit oracle.com/health or follow Oracle Health on social media.

In the last decade, a growing amount of research has increasingly exposed how a lack of funding for medical and pharmaceutical research around women’s bodies has put both patients and clinicians at a disadvantage for treating even common illnesses. With a lack of knowledge and awareness on women’s health, clinicians don’t have the data with which they need to practice, and patients don’t feel heard, some even experiencing bias at the bedside. How can AI and other technologies help address some of these challenges? Listen in on this first episode of a two-part series. Featuring: Moderator: Nasim Afsar M.D., MBA, chief health officer, Oracle Health Christy Dueck, Ph.D., global head of the Learning Health Network and Health System Activation, Oracle Health Esther Gathogo, M.Pharm., Ph.D., senior performance improvement leader, Oracle Health Sarah Matt, M.D., MBA, vice president, physician and healthcare technology executive, Oracle Health Listen as they discuss: The moment they realized, personally or professionally, there was a gap in women’s health care (2:47) In practice for oncology patient Collegiate athlete performance Menstrual health care in school settings In practice, while pregnant What is being done to address the lack of research on women and diversity amongst women (10:56) Representation in clinical trials Product development Expanding inclusivity in EHR data What can be done to help address the lack of women and women of color in clinical studies (15:11) The role of AI in care delivery (17:15) Tips for training AI algorithms Burnout, patient engagement, automation Notable quotes: “When we think about women's health in general, using more automation, using more AI/ML, could it help women in their ability to get care for themselves? It absolutely could … Because right now I think what we're finding is that the system’s stressed, all the people are stressed, the patients are stressed. Everyone needs a break and we can't do more with less. We're going to have to do things differently.” – Dr. Sarah Matt “At the end of the day, we want to make, just like you said, those 15 minutes with the community members that you serve more impactful and with the option to bring more innovative things to your community than ever before.” – Christy Dueck, Ph.D. “And we know that if there's such a low representation of women in clinical trials, it means that products are being approved without the representation of these women. And it means that the real-world evidence then becomes really important. If we are then using these products, we have to understand the female body and the diversity—in terms of the genetic background as well—and that diversity means that they might respond differently to the approved medicines. It’s also thinking about how to recruit and making it a lot simpler for women to understand the products.” – Esther Gathogo, M.Pharm, Ph.D. --------------------------------------------------------- Episode Transcript: 00:00:00 Nasim Afsar You're listening to Perspectives on Health and Tech, a podcast by Oracle with conversations about connecting people, data and technology to help improve health for everyone.  Today on the podcast, we're discussing women and health equity. From personal and professional experience, how we've become familiar with the lack of resources and research on women's health and how AI and other technologies can help address some of these challenges. 00:00:35 Hi, I'm Dr. Nasim Afsar, chief health officer at Oracle Health. And joining me today on the podcast are three of my colleagues from around the world. I'll ask them to introduce themselves and give a brief overview of what they do. Sarah Matt Thanks, Nasim. I'm Dr. Sarah Matt. I'm a surgeon by training my fellowships and burns, but I've been in product development all over the world for my entire career. That's building our electronic medical records, new mobile applications, patient engagement solutions, you name it. First, I came in to drive our OCI, the cloud side of our business for health care and life sciences. And now, after our acquisition of Cerner, I focus on new product development.  Nasim Afsar Thank you. Esther?  Esther Gathogo  Hi, I'm Dr. Esther Gathogo, and I'm a pharmacist with 18 years’ experience working across different sectors: community, hospital, academia and clinical research. And I currently work as a senior performance improvement leader in international based in UK. And I also focus on health equity and AI. 00:1:37 Nasim Thank you, Esther. Christy? Christy Dueck Hi, everyone, I’m Dr. Christy Dueck. I'm the vice president and global head of our Learning Health Network and really have responsibilities around creating health system partnerships with life sciences industries to bring clinical research as an integrated component of clinical care.  Nasim Thank you, Christy. And my background is in internal medicine. I practiced as a hospitalist for over a decade in tertiary quaternary academic medical centers. I've been in health care administration on the health care delivery side for over sixteen years in roles, in quality roles, in health management, contracting and health care operations. My team is focused on how do we ensure that across the globe we have healthy people, healthy workforce and healthy businesses. Driving the best of products and services to ensure that we're improving the health of the world. So thrilled to be here and thank you all for joining me today as we talk about women and health equity.  00:02:47 To start us off, I want to talk about the moment that you all realize that there is a wide gap in women's care and that could be either personally and professionally.  Nasim  So, to kick us off all kind of share a story from my background. This really kind of hit me a number of years ago when I had the privilege of taking care of a 48-year-old woman with end-stage metastatic colon cancer during her final hospitalization. I learned during this hospitalization that leading up to her terminal diagnosis, for about a year, she had seen a number of providers with her symptoms. Initially started off with fatigue. She then had some abdominal pains, some nausea, and this was continually attributed to stress, irritable bowel syndrome. And during those 12 months, she was really never provided the appropriate diagnostic interventions, like a colonoscopy, until it was too late.  I also learned during that time that she was a phenomenally dedicated teacher. She was a caring mother. She was a spouse, a child, a sister, an incredible friend to many. It was absolutely heartbreaking to see that her voice was not heard as she didn't receive standard of care that really could have been lifesaving. And I wish I could say that this was a rare case. But cases like this happen every single day in the U.S. and across the globe. 00:04:22 Christy, I'm wondering if you can share with us when this really became real for you.  Christy Sure. A little bit different story for me, and mine's actually personal. So, when I was studying pre-med, I was an intercollegiate athlete in rowing with aspirations of competing at the national and elite level. And like so many female athletes’ experience, I really got caught up in the cycle of being asked to lose a significant amount of weight by my coaches, because rowing, like other sports, has weight classifications. So over the course of a summer, I dutifully lost 35 pounds and returned back in the fall at under 130 pounds, which is a light weight. And in about three months I had a full osteoporotic hip fracture at the age of 20. And it was really a peak milestone for me. I was in my junior year. I was pre-med at the time. 00:05:22 I was never given, obviously, any guidance around the impact that that weight loss would have on my health, my endocrine system. And so that was really a milestone of it ended my rowing career, unfortunately. But it was really a driver for my career. I went on and got my Ph.D. in reproductive endocrinology and did a whole lot of research around the female-athlete triad since I was sort of the poster child for it at that time. 00:05:50 Nasim  What a challenging personal experience to go through. Christy, thank you so much for sharing that, Sarah.  00:05:58 Sarah So I think, you know, as I went through my medical training, you kind of see things, you hear things, if things don't seem quite right a lot of times. I think where it really hit me is when I started having my own children. So, I have four kids, and my first, I was still doing surgery at the time. And when I think back to that time, there were so many assumptions made about what I, as a professional, might already know about women's health or might know about my own body, and that I didn't. And when I would ask caregivers, they would either be like, “Oh, well, you know, it's this or it's that.” And I think that having come from the medical field and having a baseline of information already, I still didn't have the answers I needed. And I was relying on my grandma or my mother or my sister or friends to ask advice when I couldn't get what I needed out of the medical system. And as a medical professional, I needed information like, “Hey, if I'm going to go into a vascular procedure, do I need to wear lead?” 00:06:57 “Hey, is this chemical okay for me? What if I get exposed to that?” And yes, sometimes there was a paper that I could Google and sometimes I could ask my doctor, but sometimes there just wasn't. And there wasn't the right people for me to ask within the medical community or otherwise. So I can really see how people just struggle, because I had, theoretically, all the resources I could possibly want available to me, and I still couldn't get the answers that I wanted. 00:07:27 Nasim Thank you for sharing that, Sarah. It really brings out the part of the heart of the matter, which is even when you have resources and knowledge, it can be so incredibly challenging. And so many women across the globe don't have the resources and the knowledge. Esther?  00:07:46 Esther I'm just going to take us back to the early years of when you're probably a teenager and you had the reproductive health conversation. And I was in boarding school and we came back after having been given sanitary towels and shown tampons and everything else. And I think at that point the main focus was on the menstrual cycle and what's normal. But no one really talked about how bad it can be, I think for most. And so I think what became very clear is when girls, you know, because that's the stage when the menstrual cycle is being regular, more regular, and you started to see serious, serious problems. 00:08:33 You know, we had one girl who had to be taken by ambulance and started on a drip for menstrual pain, you know, and it's something that hadn't obviously seen before. And then as we got older, the conversations where I've had friends who've had a hysterectomy before 40 for benign conditions. And when you listen as a group, particularly around the problems that people face with the menstrual cycle, you realize that there's not a lot of treatment options. And this is after many years of many women coming in to the medical center and recognizing that 10, 15, 20 years down the line, we're still using hormonal treatments as the main treatment for most of the conditions.  And I think when you listen to how, you know, it's impacting the mental health, you know, the life and social life and just their well-being, then you end up realizing that over time, more needs to be done with this. You know, because I think the medical community has somehow become just complacent because they have benign conditions and they can see that it's, you know, in terms of self-management or whatever it is that women do. 00:10:06 But I think thinking about now, especially as we are working women and, you know, how stress affects your system, it's something that I think and just thinking about needing more options. And like even getting down to understanding the basic understanding of why the disease happens, you know, some of those questions are still, you know, they're not there. So that's why. 00:10:35 Nasim Thank you for that, Esther. I think you highlight the challenges of managing something that is as basic as it gets and it's biologic, and how much work and understanding still needs to happen for some of the most basic and biologic processes in women. So I really appreciate you sharing that.  00:10:56 So, we know that a lot goes into these gaps of care from lack of understanding or honestly acknowledgment of biases in vulnerable populations to lack of medical and pharmaceutical research considering women's health, I think you all touched on different sides of this. So let's focus on representation of women and women of color in research. What has been done to address this gap in research and data? Esther, I'm going to ask you to kick us off.  00:11:30 Esther Yeah, and I was reading a bit around this and just throwing out some figures that, you know, women are representative of 22% of clinical trial research. And for women of color, it's been reported even as low as 2%. It makes you think about the information in terms of the clinical research, whether it's truly representative of the diversity of women, you know, across even the globe, if I want to say it that way. And we know that if there's such a low representation of the of women in clinical trials, it means that products are being approved without, you know, the representation of these women. And it means that the real-world evidence then becomes really important. Which is where I think if we are then using these products, we have to understand that the female body and the diversity of all of us in terms of the genetic background as well—and that diversity means that they might respond differently to the approved medicines—is also thinking about like how to recruit and making it a lot simpler for women in terms of understanding the products. 00:12:51 Because one of the biggest things would be how does this product affect my body? Most of the time people are concerned about fertility, you know, and a lot has been done over the years to try and just put women's minds at ease. But it is difficult.  And this is where I find that the electronic health record and thinking about not just about that the information is within the record, but are you collecting information in the clinical care of women and representing it in that way and within if you're doing clinical observation studies, because if you've got a product and you're not, for example, collecting information on the impact on the menstrual cycle, but you're getting lots of reports from women saying they've had a few missed menstrual cycles and they don't understand why it could have been the product that they're taking. But if this information is not being captured, then it's not within the system, which means that you start you still can't glean the insights that you need from the electronic health care records. 00:14:03 So I feel that not only around and when you look at internationals looking at the numbers in terms of the proportion of women who are conducting clinical research as well, and that's quite low. So it can also then make you think about in the end, when are designing the clinical trials, is someone speaking up for the diversity of women to include them in the clinical trials or in the trial design? Because then you are collecting the information that will be useful as well for women when it comes to evaluating whether or not they should take a product or they should be recruited into a trial.  00:14:51 Nasim  So there's a real multi multifaceted problem, right? It needs to really be tackled from multiple, multiple angles as you highlighted. So, Christy, Esther highlighted how low representation of women and minorities as has carried out in clinical research. What are we going to do to fix that? 00:15:11 Christy  Oh, that's a big question, but I think, you know, we got to we got to start with working with what we have in the most effective way. And so, you know, from my angle of the world, I'm not a practicing clinician, but I've been engaged in clinical research my whole career. And coming from Cerner, we had this realization of, oh my gosh, we're literally sitting on 40 years of digitized health care data. How do we turn that as a giant lever to help address some of these broad stroke issues, like women and access to clinical research? And so in my world, one of the things that we did was create a partnership with health systems and an opportunity for them to share their data with other health systems so that we could create a searchable dataset, a real world data set that we could then work in partnership with health systems to bring clinical studies that address issues in women's health to the point of everyday health care, and use that data as the accelerant to get very prescriptive in finding women that are a match for the specific study criteria or enabling care teams to engage directly with their patient populations that may be a fit for a new, innovative trial in a rural community that would never have had that opportunity before. So right now we're sitting at this critical point in health care where we know we've got a whole bunch of data. 00:16:51 That's our quality problem. We've got more data than we know how to use. And to Esther's point, it's now making that data a lever we can pull to accelerate clinical research, to focus on the specialty groups where we've seen disparities in care given up until this point in time.  00:17:11 Nasim Agreed. Agreed. So, you know, we've talked a couple of times around the role of technology in helping address disparities. I want to focus in on the role of AI in health care delivery. What's the potential and what are the downsides?  00:17:30 Sarah So, you know, when we think about AI/ML it's been the buzzword for how many years now? And I think during COVID, everyone recognized that we have to do things differently now than we did in the past. And so everyone’s heard about ChatGPT. It's been a huge buzz. Everyone wants to talk about AI/ML, but a lot of health care organizations, a lot of ministries of health, have been slow rolling in how they deal with AI/ML over the last couple of years. A lot of that has to do with trust and why would we be concerned about that for the same reasons that health care in general has had problems for decades and decades and decades. 00:18:04 So that means whether it's structured data coming from an electronic medical record, straight from a clinical trial database, wherever that data is coming from it, we have to make sure we're comparing apples to apples. And every single algorithm, every AI model that we build out, has to be trained. So, when we think about women's health and how we can improve women's health, ultimately, there’s going to be models that are trained on data that doesn't include women. Well, how is that going to impact us?  If you think about all the different ways we treat people today, whether it's in nephrology and kidney health and the way African-Americans have been treated in the past, in terms of those algorithms, whether it's X, Y or Z, we have so many clinical rules that we use today that have their own inherent biases based on medical data from the past. 00:18:54 So if we're going to build out new algorithms, we have to make sure that we're training it properly. So things to think about for people developing these algos is: who is your set of patients that you're going to bring into this model? Are women included? Are people of color included? What other kinds of people should be included in this algorithm’s data set to make it a great model? When we think about women's health in general, using more automation, using more AI/ML, could it help women in their ability to get care for themselves? It absolutely could. When we think about the nursing shortages all over the world, when we think about how hard it is to make a doctor's appointment on a Monday, when you have a bunch of kids, when you have a job, when you think about how much time a provider is actually going to take with you … how can we automate things for the patient? 00:19:48 How can we automate things for the provider? How can we provide that small town doctor feeling in 15 minutes? How can we provide that care and engagement with less? Because right now I think what we're finding is that the system’s stressed, all the people are stressed, the patients are stressed. Everyone needs a break and we can't do more with less. We're going to have to do things differently.  00:20:18 Christy  I love that. I'm just going to jump in right now and do a high-five to you on that one, because I think, right, fundamentally—and, Nasim, you and I’ve talked about this before as well is—at the end of the day, we have to change our behavior around health and care, regardless of what side of it you're on, whether you're a provider of it or a receiver of it. And that behavior change is what's going to drive our ability to be able to actually leverage and receive the benefits of all the cool stuff, Sarah, you just talked about. But if we don't change the behavior around health care as the starting point, it doesn't matter what great tools we develop if people don't use them. And so in my world, you know, we're trying to engage critical-access hospitals who have never, ever participated in a clinical research study before. 00:21:14 And the first thought and the first line of defense is, “I don't know how to do that. We've never done that. No.” And really, it's creating that opening of, “We're here to partner with you. We've got all of the tools and technology in place to enable you to do it.” And at the end of the day, we want to make, just like you said, those 15 minutes with the community members that you serve more impactful and with the option to bring more innovative things to your community than ever before. And on the patient side, or being a community member, you know, I love all the powerful stories that I get to hear of people who are busy, women who are really busy, and now they look at participating in a clinical trial as even a control patient, as a way to give back, as a way to serve. And most of those stories end with an, “Oh my gosh, I thought I was a control patient, and I actually got diagnosed as a result of my participation in that study because I haven't done anything in my health care over the last three years with COVID” because of all the reasons we all just talked about. 00:22:22 Nasim I think you all highlighted how technology can really be used to facilitate receiving care, getting care, getting better care, facilitating your care at the time that we need. And there are barriers that we have to overcome. And I think that's kind of Christy, your point about that changing relationship.  Esther, you were touching on this. I think those are the elements that we have that we have to work through as a society to be able to move things forward.  00:22:56 Well, thank you all for joining us for this thought-provoking conversation about women and health equity. I want to thank our panelists Christy Dueck, Sarah Matt and Esther Gathogo. Great conversation around the role of technology and how can we address some of these shortcomings and limitations that we have for women to receive better care. But lots of areas identified where we really need to work together in partnership to address this as we move forward. Looking forward to ongoing dialog around this, and more importantly, action around how we can impact better health for women across the globe. Thank you. Be sure to subscribe to Perspectives on Health and Tech podcast for more insights from industry experts, visit oracle.com/health or follow Oracle Health on social media.