YouTube Video: https://www.youtube.com/watch?v=z1_oWKgfW7w
Originally Published: Jul 21, 2023
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Leading the Digital Revolution in Healthcare: Transforming Patient Care and Innovation at Tufts Health System
Join us for an inspiring session as we delve into the groundbreaking initiatives spearheaded by Dr. Shafiq Rab, a visionary leader in healthcare innovation, and his transformative work at Tufts Health System. In this session, we will explore the digital revolution in healthcare and its profound impact on patient care, operational efficiency, and innovation.
Shafiq Rab, MD Chief Digital Officer and CIO, Tufts
Megan Antonelli, Chief Executive Officer, HealthIMPACT, Moderator
Leading the Digital Revolution in Healthcare_ Transforming Patient Care and Innovation at Tufts Health System
[00:00:00]
Megan Antonelli: Hi, welcome. Today, we are so excited to have Shafiq Rab who has, I've known Shafiq since, I wanna say 2009, back at Hackensack. Maybe it was 2010. I was in a bind, if you would. I had taken over an event for someone. It was big data event, so way back then, and it wasn't even healthcare specific.
And Shafiq stepped in and shared the entire thing and it was amazing. And we have been close friends ever since. He's been at Health Impact many times and we were excited to have him join us in June. [00:01:00] But with the smoke and everything that was going on in New York, there were things to take care of at Tufts.
So, one thing that I like about Shafiq is that he is a no BS c i O and he's been that. And so he is, he is true to our brand. So, Shafiq, let's start out, you know, just talking about kind of, there's a lot of hype, there's a lot of what's real, there's a lot of there's a lot that's happened since the pandemic.
And people have moved forward quickly, but there's still some things that aren't happening that we think should be right. So talk a little bit about that and why it's, you know, what is working and why isn't everything working for everyone?
Shafiq Rab, MD: Well, so if you are talking in regards to technology and digital transformation and things like that, First of all, thank you for saying nice words about me and thank you for being a friend.
You had a great team that did the show. I just appeared, so it's nothing to do with me. Just let you know that we are all on a journey and in healthcare our journey [00:02:00] is governed by many things. The government policies. The technology as it improves, gets better place where we work, our payer mix.
Some places we work in an environment when there is more resources available. Some places it's not. Then we also work in places where talent is hard to fight. Could be rural America, could be some other place. So we in healthcare are very complex when it comes to technology and innovation. Yet, For every time we have to provide high quality, a one grade support and health and care.
So that's kind of important. And kudos to the people who work in healthcare. And in spite of all of this, during the pandemic, post pandemic, pre pandemic healthcare workers are my heroes. And they have done a phenomenal job coming to [00:03:00] technology. So, What's happening is that we all talk about, you might might have heard Chief Digital Officer, so I'm one of them.
I got it. 35 p. Chief Digital Officer to know. 2009. There was no Chief Digital Officer just to let you know in healthcare. So you're right. So what's happening is that we did, in our world of digitizing, that means meaningful use came and we started doing our electronic health record and we thought we had the electronic health record that was.
Digital transformation, that's not true. So as we are funding, finding out just by making things electronic is not enough, and just by making the electronic health record, digital is not enough. Why? Because from digital digitization, we went to digitalization. That means we started making other things digital.
For example, our fax machines, which is very important. [00:04:00] Everybody uses it to this day. And then we started using our documents, our workflows, our EKGs, our other aspect that makes healthcare ecosystem complete. While we were doing this, a revolution of cloud because we needed. There was a hype about AI predict predictive modeling.
We needed compute power. So some of us, even though we are not going to claim that we are in the cloud, but we are using Amazon, we are using cloud clearing houses, we are using cloud connect centers. We are put putting our analytics in the cloud. So we are like a amphibian. That means, pardon the water. And when we feel like we come to the land part in the water part, in the land, like a frog.
Okay? So don't quote me on that. That's where we are. While we are doing this, [00:05:00] some of us thought that, Hey, how about not only IT people, but the operational people should be involved also. So the cultural transformation of digital transformation is the hardest part. That means some people, when they. Check their phone.
They start looking for an app and they click on it. My children will just say, open app ways, and it opens it. So nobody does not do digital. You have to be digital. The difference between do digital and be digital has not happened that the country known Astonia in Europe, you can get a e residency. You don't have to live there.
That means you can get your green card for there and you can start your business in the European Union just by being digital. So what I'm trying to tell you by telling this entire story that we are on different paths of the journey, but here is the thing that is helping us [00:06:00] also stopping us. Some of us, there are steps to get to digital transformation.
What's real, what's not real. Some of us sit down in the room and say, okay, I spend $2 million or 3 million on my hardware and my next cycle is seven years from today. I don't have the time or the money to go to the cloud, so I have to wait for my cycle, which is makes sense, right? Some of us. Have to do an r o I return on investment.
We really have to sit down and different people get different verbiage from different people. And here's what is, you can love Google. You can love Microsoft. You can love a w s. Nobody's stopping you. It's not that there is only one love to follow. You can also have your private cloud. So while people are making that decision, there comes cybersecurity.
So, Not understanding that cloud is more secure than prem on-prem, and I'll, I'll talk about it in two minutes once we have [00:07:00] finished the answer to the question, is that r o i? Getting your legal team ready, getting your financial team ready, getting your operational team ready, getting the count of all the applications that you have.
At the place that I worked, I became the first person to put Epic. And about 40 applications in the cloud, in public cloud. Now we have 129 of them by August will not have a data center, but to do that, I had to know how many applications I got, so I had 800 of them. I'm not decreasing it to 1 29 or 200.
That app rationalization gives you the money to spend on the cloud. So we don't think that way where to regenerate the money because if nobody's giving you the money, then you can get it from there. Secondly, when you go to the cloud, I'll give you an example. You buy a server. You bought it, you paid for it, you use it, but you can't say, I will use [00:08:00] half the server, one for the server.
But if you're in the cloud, if you're not using in nighttime, you can decrease the compute. You can decrease. If you decrease the compute, your cost goes down so you become more official. We have decreased our cost tremendously by knowing who uses how much at what time. On top of it, somebody asks you to increase the compute power.
In a normal world, you'll have to spend three days trying to get a server sign and three months to get it done. In the cloud, you press a button. Low and behold, in three seconds you have an environment your storage increases. So that adaptability and that scalability is the benefit. But before you talk about that, people on the backend want to know, Hey, is cloud safe?
Second, they want to know how much it's gonna cost me. It's an operational cost. Then they want to know, hey, all the applications we have today, can [00:09:00] we access it the same way we used to access before? So that knowledge, that preparation has to happen from the beginning. So what's real is that we are all thinking about going to the cloud.
Some of us have secretly gone to the cloud, but the entire ecosystem is not in the cloud. Right. That's
Megan Antonelli: why. And we were just talking Steven Rockwell with Palo Alto who Participated in June, and, and we did a interview with him and he was talking about that's, you know, sort of the e H R to the cloud is the next phase, and that some people are doing it and some people aren't.
But we, we talked a little bit about why there is hesitation, and you mentioned it a little bit there, but tell me a little bit about, you know, you go to Tufts, it's a different organization from where you've been. What kind of conversations had to happen to convince the leadership there that taking all that to the cloud was the best thing?
So
Shafiq Rab, MD: I, I, I, I cheated, so I'll tell you what it is. My boss, Mike Dandruff, is already an enlightened [00:10:00] person. I don't have to convince him anything. In fact, he's like, are you done yet? So, I'm lucky to work for a person who actually understands the digital transformation process and is, is a believer in it.
But and the team that I work with, they are a believer in it. But that doesn't mean my task was easy. What that means is that I'm not talking to going to the cloud only, and, and I'm gonna tell you how it ties to digital transformation. Cloud is only computing and storage, but it opens the world to APIs.
It opens the world to cloud security. It opens the world to interoperability. It opens the world. A platform. So you become a healthcare platform from which you launch the app, from which you connect to the a p i from which you connect to other software and other places. All of a sudden you're in different place, right?[00:11:00]
So it enables you, in my case, what we did is that we allowed our legal team to take the lead to find out without me in it. We allowed our financial team to take the lead because they're our brothers and sisters. We work with them. We are one team. We allowed our technology team also to come and talk to people, and then we of course were doing the E H R, and then we were trying to do archiving.
We're trying to build a digital front door, so we went to our marketing people who are the true people who know what consumerism is. They guided us, so we took the help of the power of the organization to allow technology to prosper. We're not done yet. We still are going through operational changes.
We're talking to our chairs, our learned colleagues who are doctors and surgeons, and the part [00:12:00] that we did, which very few people do, we actually talk to patients. We actually talk to consumers that what do you want in your app, or what does digital transformation mean to you? And we also created help desk around it, people who understand patient experience.
So in short, digital transformation is bringing a revolution. And in revolution, it needs blood, sweat with the North Star that you're going through. This may not sound technical to most people. Technical part is the easiest part. Why? Because connectivity is now a hundred gig. BA is there and and also N B A is there.
Then a w Ss is the fastest at this time. Microsoft is not that behind and Google will catch up. The latency is not there anymore, and [00:13:00] then you are in multiple regions. So redundancy is not a problem either. You see what I'm saying? Technical part is easily solved, right? The, the first part is to get agreement.
Second part is the actual digitalization. When you are doing it, you find out that, how does your r o I work? This time, r O i is not a return on investment, but it is release of information. So your workflow and your processes that you do today, you have to document them because you are leaping from manual work to digital work to automation.
You can't get to automation. By not knowing your workflow and processes. There's a company, olive, there's a company, UiPath. There are one, a lot of companies that allow you to do the automation, but this SC work, when you do that, all of a sudden you can go to your revenue cycle person and say, Hey, I [00:14:00] can save you this much dollars.
So all the dollars that you're look looking for to pay for it. Came from these places before we went, and now when we are in the cloud and when we are doing digital transformation and 150,000 people have signed up for our app, of course it's a big deal. Everybody wants to use it now. So now that I'm successful, little bit now comes the more questions and more work for me because no good lead goes unpunished.
So what I'm trying to tell my colleagues and friend. Digital transformation is a cultural transformation. It needs everybody, all of us together to move forward, and there is no escape from it.
Megan Antonelli: Right. That's great. I think um, the cultural transformation piece, and we've heard that a lot. You know, we always talk about the people, the process, the technology, and that the technology isn't the, you know, that's not the challenge and it continues.
[00:15:00] Technology continues to outpace how quickly we can change our culture. No doubt, especially, especially in healthcare, but everywhere. Although, I mean, I'm struck by and excited by seeing a lot more of the digitally native, you know, in healthcare. We, you know, now physicians are digitally native as they're graduating and coming in.
And I'm curious, have you seen, you know, we've been in this a while, has, has your job gotten easier because the cultural of, you know, change of the generations has shifted.
Shafiq Rab, MD: So the answer is yes and no, and I'll tell you why. Yes. Because we have tech savvy people. Fortunately, or unfortunately, technology is not stopping.
Now, generative AI is there, right? And l l m is there. So technology is not stopping. What demand is coming? When is virtual reality coming to our place? One is generative AI is gonna help me with my inbox[00:16:00] which we are doing now. Now people are asking, I need wisdom and insight for anticipatory care.
Prescriptive care. I want to know what's gonna happen to my patient based on the longitudinal study. Gimme that insight on the spot when I'm talking to my patient. So from digital transformation, we have now become an AI company. So healthcare is transforming into an information and a wisdom company.
Mm-hmm. So the demand has not stopped. So that means we have to continuously evolve. Right. And the things that I'm saying to you, I wish I knew it before I did it. What I'm saying is that that wisdom comes, it's a hindsight 2020 hindsight. Right. I wish somebody should have done it and told me. Mm-hmm. But,
Megan Antonelli: I have done it.
That's, you know, that's the challenge you get. That's what you get from being a maverick and being a pioneer. Right. That's not a lot of people in healthcare [00:17:00] are willing to do that, but it's a great thing to see. I think you're one of the first people who I heard talk about the digital front door, and now you're talking, you know, I like that what you said about, it's not about doing digital, it's about being digital.
And I think, and, and then obviously healthcare as a platform. It's a platform you're building the tools and the hospital is, is yes one, you know, one room that healthcare exists in, but now this platform in which doctors, doctors and nurses give care and patients receive it. And it sounds like at Tufts, you're really talking to both sides to understand what it is they want.
What do you know as you look towards the future, as you look at these changing demands, what do you anticipate as, you know, where do, where do people need to prepare? What do people need to do? To be ready for those changing, changing tides and changing demands. So I'm gonna
Shafiq Rab, MD: tell you two new things are coming and which I'm working on, and other people are [00:18:00] doing in piecemeal or some have already done it and it is inevitable.
And I'll tell you what they are. First people don't believe anymore. Nine to five. Healthcare availability outside, they want 24 by seven. That means whether it's virtual care, urgent care, home care, hospital care, they don't care. What they really want is that I should be able to access care anytime.
That's the number one demand that's coming. U C V S trying to do it. Walmart is trying to do it. We are trying to do it. Other companies are trying to do it. Some have some little virtual, some are full virtual. Blue Cross Blue Sheet has a virtual. So we all trying to do whatever we can to capture the market and to need the need.
Second two demands that I'm gonna tell you what's coming in. Patients are now asking access to their own. Electronic health record so they can run the chat g p t on it. How do you like that? So, so that means they want the insight. Right. And then the thing that I'm working on [00:19:00] is that a day will come that you and I will sub subscribe like your net Netflix streaming.
What we wanna sub subscribe to people monitor my health 24 by seven. Either put a something on my chest or put something in my room that can tell you my blood pressure, my heart rate, my e k G, my spo O two, my FIO 2 24 hour monitor me not only for home health, not only for somebody who has congestive heart failure, but a normal person.
But I'm in the car. Monitor my movement in the car if I'm sleeping or not, by lay radar and lidar, right? So as long as continuous monitoring, I'll give you 20 bucks a a month and you send that continuous data, we'll set parameters to the cloud again, and to the cloud, to the E H R, to my mother, to my wife, to anybody I tell you to.
And if there is an abnormality that you are seeing, Whether it's atrial fibrillation or anything months before people can see that, I want to know. I want you to give me continuous glucose [00:20:00] monitoring the thing that you put on your, not when I get diabetes because my grandfather was diabetic, my father was diabetic.
I will be diabetic. Give it to me at the age of 30 so I can, and you look at my blood sugar. So even before the slightest thing comes in, you can tell me that post. My sugar is up early morning, my sugar is up. Those parameters people want you to monitor in a subscription model, put into your AI model and let me know what do I need to do to increase the quality of my life.
That's what's coming. Right.
Megan Antonelli: Well, I love that. I love it. I, I am reading Peter Atias lifespan actually, and he's a big investor in Dexcom, but he talks about the. Values of continuous glucose monitoring. But I, you know, and I think it's you know, it's, it, it shouldn't even be a future state. 'cause obviously there's so much, there would be so much of benefit to having that for people who are at risk of diabetes.
But I. And one thing we've talked about a little bit [00:21:00] in that, and I'll, you know, we'll, we'll close with this, but in terms of hospitals and the, you know, patients being in the hospital versus not in the hospital and, and you know, what you're talking about is Care Anywhere, right? That's, and that's what we've been talking about a lot at Health Impact and it's continuous monitoring.
Knowing when you're coming upon a, an acute act, you know, in incident that you'll be, be able to prevent it. And that's gonna keep people out of the hospital. So how are hospitals gonna remain the platform of choice and stay, you know, stay in the game? 'cause there's a lot of people looking for that you know, to be the, the monitor if you, you know, that aren't hospitals and so are there, you know, what are some of the, the strategic positionings, the, the things to do and, you know,
Shafiq Rab, MD: So the reimbursement for surgeries are not going away, so you'll still get spinal surgery, cardiac surgery, orthopedic surgery.
They'll still make money. But value-based care, Medicare advantage [00:22:00] and quality of life is important. So when I was at Hackensack Meridian Health, we had already figured it out at that time. By the time I left, we were making more money from outpatient than for inpatient. So some, some bigger institutions have figured it out.
Also the prescreening Tests, understanding for people not to get sick. So that does not decrease the income. The income becomes bad when we don't do good quality in the hospital. People who have no place to go, like we cannot do discharge disposition, but there are 30, 90, 50 80 at any time. People occupy the beds for more than six months because we have nowhere to place them.
So the length of stay goes south. So we have to also invest in housing. We have to invest in nursing homes. We have to invest in other places where people can [00:23:00] go at a lower cost. So that is happening. It's not that it's not happening. So for us, we sometimes we say we are a population health company but we have always believed in it.
The collaboration with our entire network of physicians, whether they are part of us or whether they're independent physicians, we have to have a relationship with them. So the way we are trying to, my c e o is trying his best to do that. We have created a clinically integrated network for more than 2000 physicians.
They're not our physicians, but they are our physicians in a different way. You know what I'm saying? Beds are always full in hospitals. It's not that they're not full, but we only want appropriate admissions. That means people who really need that care. We also want to decrease the readmission. We get penalized for it.
We also want to place people into more comfortable setting than living in a dangerous place, which is a [00:24:00] hospital where you get infection, other things. So in the long run, Hospitals will still be there for tertiary care, for coordinated care, for acute care. It's not that hospitals are going away, people just say, hospitals go away.
It's not gonna happen. But what will happen is that people will invest in life. That means people will truly invest in making themselves. Their health, so they're better quality of life. And that happens with the Gen Z and the millennium millennials, that they're actually interested has the chat g PT to query their own data to understand what they should do or not do.
So that's why digital transformation is important, companies and health system that will allow the patient to anticipate their care and when they have a question. They should be able to answer, and if they do not know the answer, then allow them or guide them to go where the answer is. That means we become the [00:25:00] trusted partner, valued partner in the wellness and the care of our community.
Those who do it through digital transformation will become a phenomenal company.
Megan Antonelli: Fantastic. Well, if that isn't, you know, it all, all, I've always, you know, every conversation, it's words of wisdom, words to look at and a future state that, you know, I'm actually excited for in healthcare, which doesn't always happen.
Shafiq Rab, MD: Yeah. And I'm a lot of
Megan Antonelli: complaining, but Shafiq, you have such a optimism and such an energy in terms of tackling these challenges and succeeding in uh, bringing digital transformation. And I love. The idea of, you know, being digital. 'cause that's, that is what certainly you know, we are, and, and we expect
Shafiq Rab, MD: now, Megan, the most important thing in this, I have to tell you to all my friends who are listening to this, brother, I'm with you.
I'm making my mistakes. I will share my mistakes with you sisters. I will share the mistake with you, and you make it better than I [00:26:00] did. It's a back on that we keep on passing. Healthcare will take us a lifetime to correct. It's not easy, it's complex and people need us and we have to stand up for our communities and give our very best we can.
Anything I can do, let me know, man.
Megan Antonelli: Oh, you're the best. Well, thank you so much. I appreciate it.
Shafiq Rab, MD: Thank you, Megan.