Welcome in. Welcome in. This is a webcast from NRC Health, one of many in our series of webcasts. We are so excited to have you joining for today's conversation, "Humanity at the Core." We are going to talk about digital health. We're going to talk about patient care. We're going to talk about healthcare transformation and how that all affects the experience. But at the core of that is humanity and, of course, human understanding, which has been our mission for some time and will continue to be our mission at NRC Health. I have a couple of wonderful guests today. I myself am Ryan Donohue. I'm a strategic advisor for NRC Health. I'm also a faculty member and advisor for the Governance Institute, which is part of NRC Health. I'm excited to chair up this sort of conversation that we're going to have that doesn't just include our speakers. I'll introduce them in a moment. It also includes you. There's going to be lots of opportunity for questions and answers today. You have a chat function where you can submit a question to us, and we will see that, and we will get to as many questions as we can. Questions are encouraged. We've got a lot of opportunity to talk with both of our members today. It's going to be exciting to also not pump you full of PowerPoints. If you were here to see a huge sprawling PowerPoint with a million data points, you're going to be disappointed in this webcast. This is going to be a conversation. Data will come up, but it's going to be a conversation between the three of us and all of you in the audience. So without further ado, I want to introduce our fellow speakers and conversationalists today. Dr. Geeta Nayyar, she has an excellent career path, a really cool intersection of business, medicine, and tech. She was also a speaker at our HUB 24 fireside chat, which went so well. We're here today for more conversation, and Dr. G, to introduce yourself, you were on such an interesting path to become the CMO of Salesforce and AT&T. Say hello and give us a little bit of your background. You bet. First of all, Ryan, thank you so much. It's wonderful to be here with you and Vinitha. And I'm so upset to know there will not be death by PowerPoint today. So thank you for setting expectations. Look, you know, as far as my career path, I mean, it's probably the first question I get from so many folks is just, what is a doc doing in technology and doing all of these kind of nontraditional things? But you know, the reality is, one, it's becoming more commonplace. But two, my generation of physicians went from paper to digital in our residency, believe it or not. So the beginning of everything electronic health record started in the early 2000s. And I just happened to be one of those docs who could connect the dots and really understood technology's role, not just in the day-to-day of medicine, but in shaping the future. And so I had the privilege and the opportunity to take on a variety of roles in the industry to do just that. And I think you, your audience, understands that we've done a lot. We've built a core infrastructure as a basis, but we have a lot more work to do as far as how we get the technology right for both patients and physicians and nurses and the whole care team. Yeah, you know, from a timing point of view, you were born at exactly the right time to be going through that transformation. And we're going to talk all about that. And if you want to share any horror stories when we talk digital tech, we can talk about that from 20, 25 years ago. We've got listeners who also live through that era. We also have Vinitha Ramnathan, who is with us. She spent 20 years in healthcare building innovations for everything from patients to payers to pharma to health systems to the docs, physicians. Vinitha, as you say hello to our audience, what motivated your choice to focus ultimately on experience and AI? Thank you, Ryan. Hi, everyone. Great to be here. Like you said, Ryan, I've been really fortunate to be a part of the entirety of this healthcare ecosystem. And the one thing that was constant across all of my experiences was that the well-being and outcome of a human, an individual, was kind of at the center or core of it. So whether it was, you know, a health system or a physician trying to improve outcome for a patient or a health IT company trying to improve interoperability. So the data for an individual can be freely available when needed, or a payer trying to improve risk in the population by improving member and financial outcomes. At the end of the day, it was that human that was at the center. And this human could be a consumer, a patient, a caregiver, or a caretaker, right? So they play a variety of different roles. And to be at NRC, where I get to work on that experience of that human on a day-to-day basis and add tech on top of it in a very responsible way, is super exciting. So that's what brought me here. And this journey, which, by the way, the 20-year journey, about 10 years ago, I did work with Dr. G. And back then, we were also still talking about how healthcare IT needs to be validated from a clinician's perspective and get feedback. And it's amazing that that has also continued for me over the years. This is like. Me and Vinitha were born at just the right time, Ryan. We were born at the right time at the right place. This is like Malcolm Gladwell's Outliers kind of life, or maybe, you know, a reference that my kids would get. Maybe this is the Marvel movie where the characters cross over into the same movie and then you realize a few movies ago. So this is today's blockbuster. So excited to have you both here together. I'm going to tee up a few topics for you, and then I'm going to get out of the way because you guys both have such interesting crossover backgrounds, but also you've done a lot of work on your own. And I think what unites you both, and we'll be clear by the end of this session, is that it can be so easy in digital and in IT and in AI to leave the human out if we're not really purposeful and intent on keeping the human in, which is NRC Health's mission. So I want to kick this over to you, Dr. G, to start. And then I want to hear from you on this as well, Vinitha. But what are the biggest challenges? What are those biggest boogeymen that stand in our way in terms of having a better and healthier IT structure in healthcare? IT is such a, you know, we're always talking about security. We're always talking about the risks. I want to know what those challenges are. But then I also would love to know, what are the opportunities? Like, if we can blue sky this a little bit, next five to ten years, what are out there as opportunities in the healthcare IT space? Doctor, I'll go to you. You bet. Well, the first one, Ryan, is I think we do have to acknowledge, as much as it feels like eons away, is that we are living in a very historic post-pandemic era of healthcare, right, where we have learned a lot. The consumer has also changed a lot. And telemedicine, for example, is here to stay. So I think one, acknowledging that that's the moment in time that we're at. But as a result, we also have a very serious physician burnout issue, right? One in five healthcare workers is leaving the industry only to never come back and only for us to not be able to create new docs, new nurses in time. And that really goes for the whole care team, from the doctors, the nurses, to just the entire care team across hospitals across the country. On top of that, we have a big health equity issue, right? When we look at the physician shortage and we look also at the fact that less than 10% of physicians even practice in rural health, we're really compounding the health equity issue. So we have to be mindful of that. Number two, we're living at a time, we are in a post-election cycle where science continues to have a trust problem, right? Americans still do not trust science, still do not trust the healthcare institutions in which we all operate, but they do still trust their doctor. So we know that 90% of all, 93% of all Americans still trust their doctor. But when you ask those same Americans what they think of the institution and the system, they say, well, I only trust the system about 53% of the time. What that really tells us, what that delta tells us, is that the consumer of today understands their doctor is their quarterback. They are relying on that quarterback to navigate this matrix dysfunctional system. And they understand in a post-pandemic world that the system is not, in fact, set up for their doctor's success, nor their own success as the consumer and the patient. And so that has created a real issue around trust and the practice of science, right? Thirdly, I think we have to remember that the economics are tough, right? We're all being asked to do more with less. Everyone is being asked to do $100 worth of work for $10. And that might be the biggest opportunity we have with tech is to say, how do we actually drive some of those efficiencies? Because we are all being stretched and pressed. And then lastly, I think one of the biggest opportunities, Ryan, is part of this discussion today, which is that there are so many opportunities to partner and collaborate. Every retailer seems to be in healthcare now. Every big tech company seems to be in healthcare. And every startup out there looks like they want to disrupt every part of the ecosystem. So there are ample opportunities to challenge and disrupt and get some of these partnerships right. Very well said. Vinita, where do you come out on this? Opportunities, challenges, and the like. Yeah, Gita highlighted them so beautifully and completely agree with every one of them. I just want to highlight a few examples of what she said. So margins and costs, right? We know that that's such a huge problem. We all face it every day. The premiums go up every year. So many people don't take, you know, don't get care for the year because they just kind of foot it. The hospital CEOs say that the number one issue they're dealing with is margins, right? So that definitely is a huge issue. And I recently read a stat that 60% of the denied claims are recoverable for a hospital, but only 0.2% of in-network claims that were denied are appealed, right? And that's because of that, you know, the staff shortage problem that we have, the shortage of time for these administrative tasks that we have. And so we are leaving all that money on the table, and it's causing more increases in price and cost, right? So to me, that has a compounding effect, right? The costs are rising, the staff burnout continues, the lack of margins means you're able to hire less people. It's just a ripple effect that, you know, has to be solved. And then the second thing that Gita talked about in terms of all these different companies coming up, innovation is outpacing ability to implement for the hospitals or any of the, you know, any part of the ecosystem that needs to apply it. And what do we need to do for that, right? How do we ensure that we not just are innovating, but we have the ability to see the impact of it? So yeah, a lot of different challenges. And how do we overcome them? And how do we ensure that, you know, by solving for the main issues, whether it is cost, access to care, staff burnout, we are ensuring that we are building a trustworthy, reliable set of solutions that solve for them. That is so important, Vinitha. And also in putting together that energy and that time, which Dr. G, you so beautifully said, you know, you're doing $100 of work and getting the $10. And I think we're all feeling a little shortchanged, including patients and consumers. So to your point, Vinitha, about people, you know, not even entering the fray and putting off care, you know, we've got numbers in NRC Health Market Insights that say one in four consumers right now needs medical attention for something, a treatment, whatever it might be, and they're putting off care. That number hasn't dropped that much since 2020. And then, of course, when they enter into care, they're hitting access issues immediately, and it almost feels like they're running into a brick wall. As we think about the other side of that wall, and we're being asked to do more with less, how do we sort out the hype? And I want to get to that early because in digital hype, you know, we're always being told this is the next big thing. You have to invest everything, every dime and every drop of energy you have into this thing. And stay tuned next year for what the next thing is. And so I think people get exhausted in that sense. So I'll start with you, Vinitha, and then I want to hear from you too, Dr. G, because you write about this. But what do you think is effective ways to sort of sort the hype from the reality and spend that energy and those dollars as wisely as possible, Vinitha? Yeah, I feel like the number one thing is to be mindful of the well-being of the human, right? If you keep that at the center, everything you're building, everything that you are focusing on, if that's focused on the well-being, that automatically weeds away anything that is maybe not needed, right? We don't need technology for the sake of technology, AI for the sake of AI, right? Just because there's a cool way of doing things, we don't need that ingested just because it's a hype, it's a cool thing to do. So the number one thing in my view would be ensure that well-being is in the center of it. I guess the next thing that comes after that is ensuring that anything that you're building or anything that you're focusing on from an AI perspective or solutions to some of these challenges that we spoke about has the right oversight to it, has the right amount of robustness to it. So ensure that what we are really focused on building has been validated from every angle, not just from a tech angle, but from a clinical perspective, from a workflow perspective, and then fairness. Geeta talked a bit about this. Equity in healthcare is a huge issue. So how do we ensure that fairness is a part of that? And at the end of the day, transparency comes, you know, and covers up everything I just said. It wraps it up. If we, as somebody working in healthcare IT, cannot explain how we build things, then it shouldn't be used, right? So that amount of transparency of where the data is coming from, how are we using it, how are we ensuring that there are no biases in it, or we are addressing the biases that could be in that data, how are we ensuring it's validated in every possible way, and how are we building that trust in utilizing it would be key, and then obviously, everything is done with the focus on well-being for the human. I love well-being as kind of the prism that everything goes through. And maybe also as you get down the project path a little bit, asking yourself, well, are we improving well-being with this? Or is it, as you said, you know, becoming technology for the sake of technology? We never want to do that, but sometimes that's what happens. Doctors, you've traded so much in the world of what is hype and what is reality in digital medicine. Talk to us about how to separate the two and how to go forward and not just ride along the hype train that seems to never end. Sure. I mean, look, when we talk about hype in the industry right now, we all know that this is around artificial intelligence, right? Generative AI, large language models, you name whatever slice of the pie you want, but that's really the biggest hype that we see in the industry right now. And really, depending who you talk to, not everyone is as grounded as Vinitha, right? Depending who you talk to, you know, it's basically going to either save humanity or set the sky on fire. It just depends who you're talking to. There doesn't seem to really be a middle. And what we have to remember is while AI is incredibly exciting and seems to have limitless potential, we are still operating in a world in healthcare where 75% of all of our communication happens by fax machine. So that is the reality of where we are today. And we have to approach this with some humility and an understanding that we are still learning this technology. We are still learning what it is to hallucinate, what it is to use some of these large language models. And the most important piece, I think, that we have to keep in mind, Ryan, which is really the spirit of this conversation, is that we have to keep the humanity in healthcare. It doesn't really matter whether it's AI today or something else tomorrow. And when you talk to a lot of technologists, the problem that they're actually focused on, given burnout, given that docs and nurses are expensive, is they say, well, we're just going to focus on replacing those FTEs. We're going to work on replacing the staff. And to me, this is the wrong problem to solve because we just talked about the fact that 90% of 93% of all consumers trust their doctor. So why would you remove that core humanity professional in the middle of that equation, right? Instead, the right problem to solve is how to make that limited staff faster and smarter and more compassionate at the bedside to have the ability to practice in a way that gives them more time for compassionate and joyous medicine. And I think that's the biggest opportunity that we have to keep in mind when we look at a lot of the hype that's out there. It's just that reality that doctors and patients, one, went into the field for that, but patients are looking to find someone's eyeballs when they're getting a cancer diagnosis, when they're getting a diagnosis of diabetes or lupus. And we unfortunately in healthcare make the mistake of trying to get into that space between the doctor and patient. And that's the wrong space to get in the middle of. And we've done it so many times with the EHR, with any number of technologies. So if we can really focus on actually getting out of the way, that is perhaps the most important reality to remember about every piece of technology we deploy. You know, that piece about the physician-patient bond is so important. That comes through in our patient experience surveys across the country. It comes through in comments from consumers saying, how do I get to my doctor and keeping the humanity at the core? And I would argue as well that crossover, Vinitha, your point about making sure that well-being is at the core of what we do. Well, if you have a strong patient-physician bond, that's a way to shore that up no matter what is sort of swirling and changing around it. We are getting questions from the audience. So this is good feedback already. And I would continue to encourage those questions. I've got one I want to hit right now. And this is also introducing AI, but how it sort of has a confluence with other things as well. And this question is, how might AI, digital and virtual chaplaincy compare, contrast, and intersect? And what might the future look like with these different aspects? So bringing AI, digital, and virtual chaplaincy together. And this is true, I think, of a lot of things with AI, by the way, how AI adds on to X, Y, and Z. Dr. G, I'll go to you first with this one, with any thoughts you have. And then Vinitha, you can add in as well. Sure. Well, look, I think we're at a place and a stage where we have no dearth of tools in our toolbox, right? And we're still figuring, even with telemedicine, frankly, we're still figuring out where is the right place and time for a lot of these technologies, i.e., the right patient visit, i.e., the right specialty, et cetera. So I think each of those will continue, as we learn about them, to have a role in healthcare. Perhaps AI will be very focused on triage in the clinical space, right? And perhaps more on the backend and how those things can be automated either, you know, with the virtual component or not. So I think that the nuances of it are yet to be determined. But I do think each of those will have a slice, right? Each of those will have a slice. Just like in today's world, we have call centers, but then we have one-on-one conversations, you know, need to speak to a customer service representative or need to speak with, you know, the actual care team. So I think there will be a slice of ownership for each part of the workflow. What exactly that is, I think it's too early to tell. How about you, Vinitha? Yeah, I think that one size does not fit all when it comes to solutioning. And, you know, going down just one path makes no sense. It shouldn't be all, like, we do not, we definitely don't want to put all eggs in the AI basket. I think having the ability to have different aspects of these solutions available and basically build things that are best suited for that scenario is what makes it great, right? Like the fact that technology has come such a long way that we have options and choices is a great thing. And so again, going back to the well-being, like if we can focus on that and then say, okay, that's our goal, how do we ensure that we are taking the best path to it, right? How are we ensuring that if we want to reduce staff burnout, what's our best path to getting to it? Is that a digital solution? Is that a bot? Is that coaching? Is that, you know, AI narratives? Like, so we have the ability now to cater to our audiences in a variety of different ways and create solutions that are most impactful. And so to me, like Gita said, they all need to coexist. And today we're talking about three, we could have seven, 10 down the road. At the end of the day, I feel like all of these paths are leading to the same goal. And that goal is, as long as we keep that front and center, we decide what's the best path. And when I say we, it's not tech vendors, it's really, you know, the entire care team, the entire, you know, audience in this entire ecosystem get to decide what works best for them, right? Is online scheduling the best for me or would I prefer a service to do that for me, right? So I feel like having those choices, having those options are so crucial right now. And, you know, we've spoken often at NRC Health about generational gaps and the fact that different generations prefer different things. And having some of these different options to getting to these solutions helps with that generational gap too, right? So, you know, what a boomer might prefer might be totally different from Gen Zs. And the fact that we have a ways to solve for all of their needs in a most optimal way is what's need to be. And the way you talk about it too, Vinitha, is so important because even when you're talking about the care team, there's a question here that alludes to this to a point of where does technology fit. It's almost like a member of the care team, but it doesn't displace anyone else. And that care team is really united around the patient, the human at the core of it and keeping them in the center, make sure that that bond is still there. We have another question around the sort of patient-physician bond. So I want to go down that path first before we hop over to other topics. So this question is about, can technology help healthcare or medicine scale to the population demand? I understand the physician-patient bond, and it doesn't seem like there will ever be enough physicians to offer that bond to everyone. Can this help scale a new model of care? Dr. G, I'll go back to you for thoughts on that. Absolutely. And listen, I'm a rheumatologist. We take care of very rare autoimmune diseases, which are already underserved in the population. And we certainly do not have enough rheumatologists around the country to go around. So I think that's the biggest promise of technology is absolutely the ability to scale, the ability to knowledge share either amongst colleagues and/or directly to patients. And you're seeing that with any number of now remote patient monitoring devices, telemedicine services. So I am certainly a big proponent of scaling those things. And certainly in mental health, we've seen that as we've also had a variety of mental health shortages that wax and wane throughout the pandemic and even now post-pandemic. But I think what we have to keep in mind is when we are looking to scale by removing the human factor. So what do I mean by that? The idea that a chatbot would do the entire visit, right? There is a role for AI. There is a role for AI in helping capture triage, helping capture data points, helping analyze data points. But ultimately, I think the human oversight and that relationship is the piece I'm talking about, right? And can that be done better, faster, and at scale with all of this technology? Absolutely. I think there's no other way to do it. But it's understanding what we're pointing and shooting the technology at that is critical to the success of scaling all the things that I believe the question is being geared towards. Yeah, no, that's a great point. And I think the scaling issue is always an issue. I'm curious, Vinitha, your thoughts, because if someone's listening and already motivated in the short time we've had to say, okay, I need to focus on well-being, I need to have humanity at the core, what do you say to the challenges of scaling and of thinking about how to get everybody that care? You know, care equity has come up a couple of times. Are there certain things that we can use in that way to avoid the pitfalls of we'll scale to everyone and then we kind of scale to no one? Yeah, no, that's a great question, and I read this stat and Dr. G, you can confirm it or not, but I've heard two-thirds of the time that a physician spends today is on administrative tasks, and that's a lot. That's true, right? If technology can reduce that, yeah, right? I mean, if that can be reduced by even a third, that allows scale, right? It allows them to spend more time with the patient, allows them to spend more time doing what they went to med school for and what they love to do and what they're great at. So can technology help with scale by reducing administrative tasks that are inundating our care teams today? Can we provide more information and make it handy for the care team? So when they actually see the patient, they have so much information in hand that they're not asking the same questions again, right? How do we ensure that they have the most, you know, impactful experience with the patient and the patient has the best possible experience with their visit? And how do we ensure that they get all the information handy so they spend most time, the entirety of the time solving for the problem that the patient has showed up for? And all of that will help scale, right? So if the patient understands what is expected out of them better, it leads to a better outcome. They understand their care plan better, highly likely that they are not going to have an ED visit or, you know, it's going to lead to a much better outcome, which is completely aligned with what a physician and the care team wants. So in my view, can we scale? Yes, we have to scale. That's the only way we are solving for all the inefficiencies and issues we spoke about, whether that's high cost margins or staff burnout or access issues or, you know, patients not feeling that they have the most adequate experience. The only way to do that is to ensure that we focus on these administrative tasks and try to remove as much of it as we can, focus on providing more insights before the patient shows up as best as we can. So, you know, the visit is most impactful. And then post-visit, how do we ensure that the same amount of information is given in a way where the patient or, you know, feels that they know exactly what's expected out of them so they can continue that experience into their well-being and, you know, into their journey of getting better? Can I add on to that real quick, Brian? You can. You know, I love the way you put that, Vinitha. And I think the best way to scale, if I had to pick and if I could speak for all doctors around the world, frankly, if we could point AI at all the things that clinicians hate, that is the fastest way to scale healthcare. And that is things like prior authorization. How can you quickly do whatever value-based care documentation metric satisfying things you need to? Because the reality is it takes me about 30 seconds to make a lupus diagnosis, right? And similar for any of my colleagues. So it's not that I'm super fast. That's just, that's the easy part. That's what we went to school for 30 years for, right? We didn't go to school for these things. And so these are the things that make patients wait in the waiting room. This is what drives the inefficiencies in healthcare. It's not because I'm, you know, in the back trying to figure out a diagnosis. That's not the issue. The issue is all the things that you just talked about, and if there was ever the biggest opportunity to scale, it's on those things, and that's how I would simply put it: all the things that doctors and nurses hated. If we could just focus AI on those things, because the things we enjoy is actually seeing the patients, and there's ample ways, and they're such mundane data entry type of logistics that can easily be automated by AI and help us scale. Your point about, you know, how this could improve the actual experience. Nothing's getting in between the physician and the patient is so well made. I think sometimes when we think about scaling, we have a big broad view of it, and we're talking about initiatives and technology and capital investments, and we're forgetting about the actual material changes that it creates in the patient-physician bond. I love you both zooming in on that. I've got another question about essentially AI and all the latest technology, but in terms of how big we go here and if we put all of our chips in. This question, first of all, they say hi, Vinitha and Dr. G, so they're saying hello. We have a very friendly audience here. The questions are starting to flow. Keep those up, everybody. We'll get to as many as we possibly can because I'm glad to throw out my question list. I'd love to hear it from the audience. This question is, with the intention of keeping human in the loop, at least for the clinical setting, do you think this allows an opportunity to go full throttle in implementing AI and technology at large in rev cycle? Being cautious, sure, but exploring every possible avenue for automation. I'm going to pause that question for a split second. I'm going to go to you, Dr. G, first, but I'm going to add this. I really like the spirit behind this question because most of the healthcare organizations I'm talking to are all incredibly cautious. We're drafting up the rules for engagement, and I understand why they're doing that, but I'm not really sensing anybody that I'm talking to that has the spirit of going full throttle into implementing AI and the latest tech. I'm curious your approach on this and how we balance the caution with an opportunity that frankly could pass us by. Dr. G, what are your thoughts? So look, I think it's a bold, I think it's a bold vision. I think it's where we're ultimately going to get, at least on the revenue cycle side. But I think with any new technology, not just AI, it's important to crawl, walk, run, right? So important to do those pilots, important to figure out what part of rev cycle versus the whole shebang, right? And understanding that I think we are still at a place where ultimately some human oversight is needed for the final, final, right? We are talking about important pieces. We're talking about finances, right? We're talking about the piece that is one of the biggest barriers to patient care is the financial piece of healthcare. So I love the bold vision. I think there are ample opportunities in the rev cycle space to automate. I'm not sure if we're there to go full throttle, but I encourage the vision and I think we go for it, right? In these pieces that are cautiously optimistic, if you will. Vinithha, where do you come out on going full throttle? I'm aligned with Geeta on this, right? So I think AI augments, it adds on, right? We are at that point where, you know, we can train it, right? But it's something that needs to get trained. So the training to me implies that there needs to be a human in the loop, right? There needs to be some element of oversight, right? And does it make things faster, easier, better? Yes, for sure. But can you completely eliminate the human from the loop? I guess not, not yet, right? I don't know if we'll ever get to a point. I feel like it's always something that will augment what you do, make things more efficient. And specifically around rev cycle, there are some very fascinating AI solutions out there, right? We've seen everything from automating prior auth to billing to, you know, claims adjudication. But, you know, it's also an area where a minor mistake can have huge impacts, right? If somebody's prior auth is canceled, that should not be. I mean, imagine the impact it has on that patient and their well-being, right? So these models need to be tested, validated, and having, you know, personally, I feel like ensuring that there is a human in the loop, validating the model and ensuring that it's learning and getting better every day, every time it's being used makes me trust it more. So full throttle, not yet, but definitely, is it getting better, faster, more efficient? Yes. Half throttle maybe. Maybe we go half throttle. Maybe we find the right spot in the middle. I mean, the point is very well made. I think consumers are in line with this. So, you know, NRC Health's Market Insights, it's a national study of consumers, huge body of consumer intelligence to pull from. We asked them, you have three choices. Do you want just your doctor with no AI augmenting at all? Do you want just AI with no human around, no human in the room, as you surmise, Vinitha? Or do you want a combination of the two? Doctors, I want my doctors was number one. So it goes to a point both of you have made. I want doctors plus AI as well. I like that idea. If it augments the doctor, not the doctor augmenting AI, but AI augmenting the doctor, and very few, it's in the teens in terms of percentages that I want AI only. If we know this, if we're in alignment, we understand what the consumer wants as they become our patient. What about on the inside? This next question is from the audience, but I think it's a really good one about change management. So the question goes as such. What would be your number one piece of advice regarding change management when introducing AI tools, such as digital agents, for example, to the internal teams and mitigating fears of being replaced? And we hear this a lot. This is, so, you know, Dr. G, you talked about there's folks saying it'll save humanity or it'll set the sky on fire. For the folks who say set the sky on fire, even if they don't really think the sky will start set on fire, some very bad things will happen, like I'll be replaced or displaced in my role. And I don't want that. So how do we allay fears? How do we have honest conversations? And how do we push some change management regarding introducing these AI tools that we need? Dr. G, I'll go to you first. Sure. Well, remember, the first thing we have to understand about the workforce that we're trying to implement AI and other new technologies in is they're very burnt. They're very burnt from the EHR. They're very burnt from the idea that we did a lot of technology to doctors, to nurses, and to patients, not with doctors, with nurses, and with patients. And I think that's the biggest opportunity to win back both the trust from the staff as well as to get it right, right? You've got to have clinical leadership from the beginning, just from even the beginning conversation of should we do this, should we not, very similar to our discussion here. You've got to have heads of departments. You've got to have the everyday nurses in the OR, nurses in the doing triage, et cetera. That is fundamentally critical, not just to building trust with the implementation, but with the entire strategy. So that conversation needs to happen early. I think we also have to acknowledge where we've gone wrong. And every hospital system around the country will not debate you on the fact that the EHRs have not been a success, right? And so you're not coming from a place of strength. And the best place to always approach that is being accountable and saying, we don't want to make that same mistake. So we want to do change management differently this time and give us the feedback and help us see around corners and help us realize where we might be solving three problems, but creating five new ones. Can you help us mitigate that risk, right? I would also say that the biggest naysayers, you know, one of the principles in change management is if you do have a group or the biggest anti, you know, anti-EHR, anti-AI, whatever it might be, if you can get those folks in your corner, they will also be the biggest supporters of you and the biggest ambassadors of your rollout and your strategy once you've won them, but it will require getting those skeptics on board earlier than later. You know, that's such a great point, and I feel like within that, as you started out and then answered, Dr. G, about leveling with them about how some of these things didn't go well or they were done to you instead of with you in the past, it seems like that would go a long way, which is transparency. Vinitha, that's something that you mentioned at the outset, is we work through these issues. We've got to be transparent the whole way, so on change management, Vinitha, where do you come out on that? Yeah, I feel like, you know, there's no way you can implement anything, any change in the system, whether it's through technology or process, by making it a top-down, let's get it done kind of a view. It has to be done in a systematic, you know, way where people who are impacted by it are part of that, right? So when we launched Huey, our AI engine, our LLM, we built it with our clients. We built it with use cases that they told us about. And every one of those use cases and what we have built and what we are building is focused on a personalization component. And really what it is, is, you know, it's taking use cases where they've said, where the care team says, hey, I would like to do more with my time, and I'm stuck doing these things, like Dr. G said, "Things that I hate, right? I'm spending way too much time trying to figure out data and looking at data and looking at individual comments to figure out what it's trying to tell me. I'm spending way too much time trying to do the math, trying to reach out to different departments and getting information from them. So can AI help me with some of those tasks?" And those were the asks we got, and we continue to get, and we're continuing to build solutions that are personalized assistants. And the reason they are assistants is because, to your point, they're not replacing you. They are your assistants. They are taking away tasks that you don't want to do or you would much rather not do and focus on something that's much more higher priority, more strategic, more aligned with where you want to be. In my view, that's really what AI is focused on and is trying to do. Now, in some instances, if it is trying to replace a doctor, then there's a question there, and you need to take a look at it and say, is that what the market wants? Is this a hype or is this a reality to your previous question, right? Like, do we need? And there could be instances where in rural parts of the world, there might be a need to create technology because there is no supply, right? But in most instances, tech is focused, should be focused on augmenting and helping and creating assistants so that the, you know, some of the issues we talked about in terms of, you know, supply-demand issues and the burnout issues are addressed. Doing that in conjunction with that team is how you do change management, right? There's almost no change management if it's coming from them. If the team says, I need a personalized assistant to help me, then it's really not a top-down decision at any health system. It's really more of a, you know, the actual users who are impacted by whatever inefficiency exists is asking for help. And, you know, there are folks who are willing to create solutions for them. That's the way I feel you can implement some of these solutions and see success. Otherwise, if it's imposed and if you're doing it for the sake of doing it, you're not going to see any success from it. It's a really good point too, because in some rural areas, and I was just with some of our clients of NRC Health at the Heartland Healthcare Alliance, so we're in the Midwest. We got a lot of folks who are really far away from a doctor where, to your point, Vinitha, there may not be a doctor to replace. And so in those senses, can AI help fill some of that role? And can technology bring those people to a doctor when they need it? Do you guys see that in rural areas? Let's ask about that. You know, we're always, for some reason, when I'm thinking of AI, and maybe I'm not the only one, maybe I am, I'm imagining, you know, a huge medical office or an urban area and people coming through in a quicker way. But we've got a lot of folks out there driving a long way to the doctor. And Dr. G, I'll flip this over to you, because I know you've seen the populous parts of the U.S. and the rural parts of the U.S. too. When we think about AI and maybe all of the tech that we're kind of bundling together as now and next generation, what are the effects, if any, in a positive nature for those rural consumers who don't have great access to care right now? Open, you're on mute right now. Sorry, thought I hit it. Here we go. You can hear me? Yep. Okay, great. You know, perhaps the only silver lining that came out of the pandemic is the fact that telemedicine is just medicine, right? We talked for a long time about telemedicine. We had concerns about liability and licensure and will doctors go for it? Will patients go for it? And the pandemic really changed all of that. And now we live in a world where hybrid care is care, right? And the community that has most benefited from that is in rural health areas, right? And frankly, in metropolises, where many times the barrier to entry was simply convenience, the idea that you have to drive and wait in traffic, right? Maybe not even necessarily geographic barriers, but this idea that there was this barrier around just simple convenience. And so that has largely changed the way that we think about health equity and the opportunities that we can really make an impact in so many of those areas. I would still say we have work to do, Ryan, right? From a legislative standpoint, we have to make a lot of these things permanent. The reimbursable nature of them, the liability protections, the ability to go across state lines. There's still a lot of unclear final decisions that we'll have to see what happens on the policy side. But I think we have even more technologies available to us to solve for those. And we also have a variety of technologies, whether it's remote patient monitoring, video visits, or just a good old-fashioned phone call. We have started to understand where and when these technologies are used and where and when communities trust them, right? Because sometimes the idea of measuring every biometric data point you have is not actually something the consumer wants, right? But once in a while, can I get on a weight scale and we can talk about it? Sure. So I think we're learning all of those nuances still and what can and cannot be done in the home. Vinitha, where do you come out on this idea of urban versus rural and even folks in an urban area that don't have the level of access that you'd assume they would or that they really want? Yeah, no, I, you know, obviously I'm not a physician, but when I hear and read and see updates on how surgery is happening in a remote area in Africa or India through robotic surgery or, you know, how through wearables, Software as a Medical Device, you're able to predict, you know, that somebody is going to get a heart attack. It's amazing, right? We've come a long way, and, you know, to Dr. G's point, right, there is always, you know, you've got to make sure that there is balance in what we do here, but the fact that there is not an availability, whether it's in a rural area or it's, you know, circumstances where, you know, you might not think you need to see a doctor, but you're having changes that could imply that maybe you're having something happen to you. It's kind of nice that technology, Software as a Medical Device, all of these have come a long way where there are solutions for you, and again, being on the product innovation tech side, what I like to see is a lot of these go through rigorous evaluation through whether it's the FDA process or, you know, international laws and regulations that are imposed on these kinds of technologies is good to see, and that's really where, you know, more work needs to happen, but the fact that there are these innovations coming up allows us to ensure that, you know, A, there is equity and access, right? Whether, you know, the person's in a rural area or an area where there's more demand than supply, and the well-being is a front, you know, front and foremost, right, so it's great to see that kind of innovation happening. You know, there are enough checks and balances and regulatory, you know, rules that apply on it, but it's never enough, right? So I think a lot of focus will continue to be on that aspect of it to see how we ensure that whatever we are building, there's transparency, there's security, and it's being built with that in a most ethical way and with the patient or the consumer's well-being being the top priority. And that gets back to this, and especially the scaling issue as we're trying to solve big problems like access, which we've talked about, or disparities, which we've talked about. This gets back to something that Dr. G, you mentioned briefly, which was trust. I know you have a lot of thoughts about this. So for this next question, this is near and dear to you, and I want to hear from both of you on this. But how do we scale trust? Because trust seems to be coming back. We know that we lost some trust during the pandemic. We know that there's a lot of different opinions out there. It's a divided country. But ultimately, we want each patient to trust us. If we're providing care at a medical office or as a huge health system, I think there's a renewed focus on building up patient trust in a way that I didn't hear five years ago or ten years ago. It seemed like we were focused on brand loyalty for a while and just kind of assumed trust was part of the picture. And we know that we can't assume that anymore. So Dr. G, when you think about trust, how to scale trust, how to build trust, what are some things we need to know as we head into 2025? Sure, you bet. You know, I spent a whole chapter on this in my book, Ryan. So I know we won't get to it all, but chapter eight, if anyone out there gets a chance. And really in that chapter, when I asked the same question, I spent a lot of time with marketers, right? I spent a lot of time with marketers to say, you know, healthcare's got this brand problem, which is that we're losing trust in science. And how, you know, how do you go about that? And it was interesting whether you were talking to the Chief Marketing Officer at the Cleveland Clinic or of Bacardi and all and a variety of brands that I sort of included in the book, they all said that you've got to do what's called the know-like-trust methodology. And again, this is for an enterprise, meant, right? This is meant for an enterprise strategy. And essentially what it breaks down to, Ryan, is that marketers have said, look, consumers take money out of their pocket and will do business with you when they first know you. Then secondly, after knowing you, they like you. And then thirdly, after they've known and liked you, they feel like they can trust you and they're willing to spend money on you. Now, when you apply that to healthcare, the first thing we have to acknowledge is that we've never thought marketing was important. Marketing has always been cute. It's always been a nice to have, right? We save lives. Marketers market. It was always looked at as very much a nice to have. And that was one of the things I learned in sitting with marketers as they said, healthcare's changing, right? 59 million consumers go to social media and make healthcare decisions. And so if you're not marketing, right, you're missing out. You're leaving this big gap open for the audience that you serve. And essentially, I walked through a Cleveland Clinic use case, Ryan, where it was very much a team sport. First of all, it was a CEO imperative, but the chief marketing officer worked with the chief medical officer and essentially achieved know-like trust by, one, ensuring they had a digital footprint, which meant more than a website, right? It was earned media, traditional media, new media. Secondly, on the like side, look, he employed help from the chief medical officer and said, we've got to start looking like our communities. And we, for the most part, have staff like that, but we have to start putting them out there, right? Women like to see women. Minorities like to see other minorities. That's important. That's how you get to the like, but then the last part, trust, Paul Matsen of Cleveland Clinic really actually leaned into telemedicine because he said, look, when people have a problem, we got to be able to answer the phone call, right? That's what trust is after all, is that when you have a problem, I can call you and you help me. You pick up the phone and you help me each and every time, and we have history together, so he said, I can only do so much as marketing. I need the CIO's help to build a telemedicine strategy, right? And to build a product roadmap that leads to a communication channel that's 24 by 7, and so the long and short of it is that it is a team sport. It requires the Chief Marketing Officer, Chief Medical Officer, CIO, CTO, where it requires people like me and Vinitha working together along with all those other C-suite executives. And it's not a cost center. That's perhaps the most important thing to understand is that if your institution is interested in scaling trust, if you're doing it right, there is an umpteen number of ROI on each patient interaction because you really are building that patient acquisition, retention, and brand loyalty strategy when done well. And Cleveland Clinic has all kinds of metrics to back up the amount of work they did on this. For a second, I thought I was listening to the audiobook when you said chapter eight, so that was great. You gave us a little snippet, and you also, you did a fantastic job hitting trust on our fireside chat at HUB 24. And for those interested in seeing Dr. G, you're going to be at The Governance Institute at our leadership conferences and a lot more things this year that folks can hear you live and talk to you live. Vinitha, you've done a lot of work in this field, and especially with product solutions that the idea was to build trust. Whether it did or not was a question we always have to ask, and I'm just curious, when you think about your experience and how we have these organizations so eager to build trust, maybe without totally understanding everything that's involved there, as Dr. Gladwell laid out, where do you come out on this and how do you inspire folks to build trust in the future? Yeah, like Dr. G said, trust has to be earned, right? You can't demand trust. You have to show it time and again that what you are offering to them, whatever the service is, right? Whether it is care for the patients or technology for health systems, trust has to be earned. So, you know, I feel like we have repeatedly kind of, you know, made sure that we are not only solving for, you know, solving for their needs, understanding their needs and giving them solutions that matter. We are going back to them again and again to ensure that they feel like what they are getting is something they can trust in, right? And so you cannot build solutions in a silo. You cannot, you know, provide services in a silo. It has to be in a partnership. And partnership is what helps with building trust. Whether that partnership is between a patient and a physician or that partnership is between a vendor and a health system, that partnership where there is a joint goal of a good outcome is what builds trust, right? So if the partnership between a physician and the patient is where the physician's just providing them what to do and not fully invested in the outcome, which they never do, by the way, then there would not be that trust, right? So the, you know, the Net Promoter Scores indicate that where the patient feels like, okay, I have had a great conversation and the doctor validated my need and I felt like I know exactly where I'm going, it gets a great score, and that's really where the trust is built. The same thing applies to products that my team builds where, you know, we are building it with them for a common goal, common outcome. We are not just giving products and saying, hey, use it, right? It cannot be that. There has to be an element of partnership for a common good, common outcome. And that's what builds trust. And trust is earned and it takes time. That's so true. And I also think how often do we go through a partnership or we're going to acquire or we're going to build something, we're not asking about building trust then. We're so focused on building something else. And then we get to the end of those initiatives and say, hey, you know, why don't enough people trust us? Or how do we build trust now, sort of divorcing it from the actions that can actually build trust? I think that's very well said. And both of you have such a great approach on this. We got five minutes left. And I want to give you both one more sort of surprise question here because everybody that's listening today is going to go forward to whatever they've got next, another meeting, maybe lunch if you're lucky, or an inbox that's full. And they're going to hear AI. It's like as an industry, we're paid per mention on AI, right? And we're no different. So when they go hear AI, whenever that is, in 10 seconds or in 10 minutes, maybe by tomorrow, what do you want them to think? How do you want to filter that next mention of AI so that they can go forth and best build this world that we've talked about? I'll go to you, Vinitha, first on that, and then I will let Dr. G close. So next time they hear, read, or see AI, how should they handle that? That's such a fun question, and, you know, the next time they see or hear AI will probably be the second they get out of this conversation because it's everywhere, right? I don't know how you avoid AI anymore. It's everywhere. I think when they see it, I guess really, you know, do I trust it, right? The word trust comes in. Is this misinformation? I know Dr. G talks a lot about it in her book. Is this information valid? How do I ensure I can trust it, right, so AI is all over us, you know, asking the right questions to say, hey, do I understand it? Is this transparent? If I ask it how it was built or how it's giving me the insights that it's giving me, is it going to give me an answer that makes sense to me, right? Would I trust it with my well-being, with my family's well-being, with my, you know, team's well-being, et cetera, right? So at the end of the day, you know, that is what I would encourage people to think about is, you know, it's all across, it's everywhere in everything you do. Just make sure that you are able to parse out good information from bad and ensure that, you know, there is enough transparency where you feel you can trust it. It's secure, it's ethical, et cetera. Dr. G, where do you come out with this? You hear AI, what should you think? Sure, sure. You know, what I would say is to remember the lessons learned from the EHR era, right? Which is to not get lost in the noise and to first do what Vinitha talked about earlier, which is to validate. What are the problems right now in my organization that my staff has, right? What is it that the doctors and nurses are uniformly giving feedback that X, Y, and Z is broken? So first knowing that, independent of any technology. And then secondly, could AI help us with that, right? And then thirdly, engaging those same clinicians to say, if I did this to help you with this problem, would that work for you? Is there anything I'm missing? Are there three new problems I would have created for you that, you know, if we hadn't had this conversation, this would actually happen in the field, i.e., help me look around the corner, right, so it's, you know, just to repeat it back, Ryan, right? It's understanding the problems in your organization. What are the pain points? Independent of the technology, what is it that slows the staff down or gets care delayed in a healthcare environment? And then secondly, can the technology actually help or hurt that problem and validating that with clinical leadership? That's really, it's that simple. It's really that simple and the last thing I would say on closing, Ryan, is to be bold, right? Because this is the most exciting time to be a healthcare leader. If I think about when I started as a young doc, I mean, we had email and phone. We didn't have texting. We didn't have remote patient monitoring. We didn't have telehealth. We didn't have an EHR. We didn't have AI. If I was, you know, 20 years younger, I would say, man, this is just starting. It's just starting. So not to be afraid to be bold, but to make sure you've got that stakeholder input and to crawl, walk, and run. To crawl, walk, and run, but get going because the goal is to run. The goal is to run and to not be afraid and to be cautiously optimistic and go forward. Very, very well said, and I think we've given people a lot to think about and how to ground themselves with some of this, and yet in being grounded, how to also be really excited and feel that energy pulsing through on some of the things we could achieve as an industry. You guys both did great on the surprise question too. I always like to do that for fun. It's fun for me, but you also handled the audience questions well. We had great participation. We had several questions from the audience. A few more we didn't get to. We'll keep a record of those and follow up with you if you asked a question that we weren't able to answer. Love this participation. We're at time, so I'm going to let everybody get back to their day, but they'll have something in their quiver to think about AI next time. And I want to thank both Dr. G and Vinitha for joining us today. You bet. Thanks for having us, Ryan. All right. Until next webcast, good luck, everyone, and don't forget the power of human understanding. This has been NRC Health signing off.