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The Voice of Healthcare - Episode 9

Co-hosts: Dr. Matt Cybulsky (Principal, Ionia) and Bradley Metrock (CEO, Score Publishing)

Guest: Dr. Teri Fisher, Founder,

and Clinical Assistant Professor, University of British Columbia.

Duration: 29 minutes, 29 seconds

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Bradley Metrock: [00:00:14] Hi. And welcome back to The Voice of Healthcare episode 9, for March 2018. My name is Bradley Metrock. I'm CEO of a company called Score Publishing based here in Nashville, Tennessee. My co-host on The Voice of Healthcare is Dr. Matt Cybulsky. Matt, say hello.


Dr. Matt Cybulsky: [00:00:36] Hello America. Hello Teri in Canada.


Bradley Metrock: [00:00:40] Hello America? This thing is heard all over the place. But we'll roll with it, though. Matt, it's great to be back with you. Our guest on the show is Dr. Teri Fisher. Teri, say hello.


Dr. Teri Fisher: [00:00:51] Hi there guys. It's a pleasure to be here with both of you.


Bradley Metrock: Teri, you are the host of the Alexa in Canada podcast, which is one of our VoiceFirst.FM shows in the network family here. You're a practicing physician. Tell us a little bit about yourself, your career, and what you do.


Dr. Teri Fisher: [00:01:09] Sure. Thanks again for having me on the on the show. It's a real pleasure to be here and it's also a real pleasure to be part of the VoiceFirst.FM network of podcasts, so like I said, I feel very privileged to be part of that.


Bradley Metrock: [00:01:21] And we did not pay you to say that.


Dr. Teri Fisher: [00:01:24] No, you didn't. You did not. But it's great. I've met a lot of great people through the connections and it's fantastic. As long as it helps to get the word out about more voice-first technology then hey, I'm all for it. But getting back to your question here. Here's a little bit about myself. So I'm what I used to call "the perpetual student". I was in school forever. And I did a number of things. I started off going to McGill University in Montreal, where I did my science degree in anatomy and cell biology and biotechnology. And then after that, I did a little bit of research in experimental medicine, specifically in respiratory health. After that, I decided that I actually might want to be a teacher. So I did a Bachelor of Education degree at UBC. But then I changed my mind and I decided to go to medical school. I went to medical school, and that was in Vancouver, at the University of British Columbia, which is now where I practice. But after medical school, I went to the University of Edmonton in Alberta, where I did a family medicine residency, and then I did a sport and exercise medicine fellowship. Currently, that is primarily what I do at the University of British Columbia. I practice sport and exercise medicine, and that keeps you busy. It's a lot of fun. For the technology side of things, I've always been sort of a tech geek, if you will. I remember back in high school....and I'm dating myself here, but you guys may remember the very very first sort of PalmPilot. It was even before the PalmPilot. There were these little Casio type, almost like calculators, and they'd flip open like a flip screen.


Dr. Teri Fisher: [00:03:05] And I thought it was really cool, because I could put in my friends phone numbers, and keep track of things in there. And then it progressed from there to the PalmPilot, and then to....when the iPhone came out, I thought I had died and gone to heaven, and then it continued to progress from there. And all through the years, I've really enjoyed, as a hobby, dabbling in digital photography and video editing and audio editing and music and the whole bit. As technology progressed and I became more and more aware of what was going on in voice tech, and particularly with Amazon Alexa, I was just enthralled by it. I was so interested, and I decided to find out what was going on in Canada, with regards to voice technology, but specifically Alexa....and this was only a few months ago now. And when I searched for any information on Alexa, in Canada specifically, I couldn't find anything. And I thought, "Hey! This is perfect!" It aligns with my interest in technology. I thought that this could be an opportunity for me to use my education background and teach people teach consumers, teach people who are interested in technology, how Alexa can help them in their everyday lives, and also how we can use the technology in all different sectors, particularly in healthcare as well, given my background in medicine. And so that's how I got involved with voice tech and Alexa in particular.


Bradley Metrock: [00:04:36] That's beautiful. Thank you for sharing that with us. So we're very fortunate that both Dr. Teri Fisher and Dr. Matt Cybulsky will be speaking at The Voice of Healthcare Summit taking place Tuesday, August 7th, in Boston, Massachusetts at the Martin Conference Center at Harvard Medical School. Don't miss that. It is Check it out. You can get registered on there as well. Shameless plug. First question for you, Teri....well, I should say not such a shameless plug for this purpose.


Dr. Teri Fisher: [00:05:13] That's a great point.


Bradley Metrock: [00:05:16] So not a shameless plug at all. Actually very un-shameless. Teri, I read your article. So Teri wrote an article, which is on, which is the hub for Alexa in Canada, which he's put together. It's a phenomenal site. We will link to that in the show notes. The article is called "How Voice-First Technology Can Transform Canadian Healthcare: The Right Care, The Right Time, The Right Place". Terry, I just got done reading this thing, this is a phenomenal article that you've put together. Share with me and the audience what prompted you to put this together and talk about the theme of the article, wet people's whistle to read it, and the efficiency gains you talked about that could be possible with voice-first technology and how it can solve some of Canada's problems. Share with us some of the perspective behind the piece.


Dr. Teri Fisher: [00:06:14] What has become apparent to me over the last couple of months that I've been really getting deep into Alexa is that Canada really does not know what's going on when it comes to voice-first technology. And yes, that is a little bit of a generalization. I'm sure some people are going....some people that are deeply involved with it are going to maybe not quite agree with me wholeheartedly there. But on the whole, I find that....and I have to say part of this is because Alexa has only just arrived in Canada as of December of 2017. So it is very new. Just to give you one example here, I was actually at a health tech incubator event just a couple of weeks ago with a bunch of UBC students. And I actually pitched a project to the group to create a voice-first technology health "navigator," which I'll speak about in a moment in this article. And I was amazed at the number of students in engineering, particularly in computer science, who, first of all, hadn't even considered voice technology as an option at this tech incubator, and when they heard about it....the amount of interest that was generated....I literally had to turn people away from joining our team. They were trying to pitch themselves to me to join our team because there is so much interest in it.


Dr. Teri Fisher: Now having said all of that, I wrote this article because like I said, I feel that there is a lack of knowledge and a lack of interest in the benefits of voice technology and what we can do to hopefully revolutionize not only health care, but really voice technology....and I'm preaching to the choir here but for those of us that know it is going to completely disrupt all sectors. When I started thinking about healthcare particularly, and as I wrote in the article, I can still remember back when I was a medical student about 20 years ago now, and people were talking about how wonderful the Canadian healthcare is on one side because there's access for everybody, which is fantastic, and I am very proud of that as a Canadian. But on the other hand, because of that, there are definite limits in terms of how much care is available to the population. And there are huge wait times to see doctors, to get to see specialists, to wait at the emergency departments. And it's not unusual for people to have to wait weeks months in some cases believe it or not some some people have waited years to see a specialist, to get a healthcare problem looked after. And as far as I'm concerned, there's lots of money being thrown at the system, but nothing has really changed since I've been practicing medicine, since I was a medical student. And so I thought now is the time when there is going to be, well, there is a complete market disruption on the way people interface with computers. Voice is now the operating system, and it's going to become the operating system of the future. And I started to think, "Well, how can this radical shift in technology potentially change health care in Canada?" And people have talked about how for an optimal medical system to function, people should be able to obtain the right care, at the right time, at the right place. And so in this article I break down how I believe that voice technology, a voice-first service, and that could come in a wide variety of formats, could provide the right care at the right time at the right place. That's sort of the overarching summary of the article.


Dr. Matt Cybulsky: [00:09:49] My father trained in Manitoba for medical school. And I had cousins in Canada and they had to wait for getting their knees fixed, or they had to wait for having their tonsils removed. The big fear from a lot of the Canadian-born physicians practicing in the U.S. was access and wait times if the United States under the Clinton administration, and not to get too political here, took us to a place where there was this big mythical idea of socialized medicine in the States. Now I haven't thought, until I read your article too deeply, about how Alexa might impact a system like Canada. But you seem to hit the nail on the head that Alexa with its capabilities for patients to be able to be integrated with a caregiver, whether it's a nurse, practitioner, physician, specialist, or an other might be able to close a gap in the Canadian system, that for a very long time, has probably been on a glaring sore that Canadians themselves, as happy and prideful as they seem to be about offering care to older citizens, might be able to close. What are your thoughts on that itself, as far as like somewhat of a zeitgeist of change for Canadians and maybe even U.S. practitioners?


Dr. Teri Fisher: [00:11:07] Yeah, that's a really, really great question and a great comment. I personally believe that this could be the key spark that we need in our system to really make a change. Just to kind of play out one of the scenarios that I outlined in this article, one of the problems with healthcare is that there's a real backlog of patients that are in hospitals because there isn't the appropriate nursing care beds. So people are left in hospitals for longer, which means that people who are waiting for elective surgeries don't have a bed in the hospital, which means they can't get into the hospital. And the same sort of thing happens in family doctors offices, where doctors offices are clogged up with patients so a patient that needs help doesn't know where to go, so they go to an emergency department, and the whole system is trying to juggle these patients in a way that is currently so inefficient.


Dr. Teri Fisher: So I can imagine a place where we could have an Alexa device or some other device in a person's home who is basically their personal health assistant or their personal navigator. In fact British Columbia, the province of British Columbia has a service that the province pays for, it's an 8-1-1 phone number that a patient can call, and they call these people, the health navigators, the health service navigators. And the person can call and ask for medical advice. And so this person will tell this person, maybe it's some first-aid advice, maybe it's "you should call your doctor in the morning", maybe it's "you need to go to the emergency room right now." But I think with the appropriate AI, why couldn't Alexa do that? So you'd have somebody in their home. You've got your own personal healthcare navigator, as the provinces call these people, but you've got this AI navigator in your home, the person talking to the navigator would have less friction. There wouldn't be that sense that that person is burdening the system. They wouldn't have to actually physically get up the phone and make a phone call. They literally looked to their side, or don't even look at any particular place and just say, "Alexa! I need some advice." Or whatever the command is and they started dialogue.


Dr. Teri Fisher: [00:13:13] And Alexa goes through a series of questions helps to essentially triage the patient at home. So that addresses the issue of where is the right place for this care. Maybe the care is at home and maybe this person just needs a reminder to take some medication, or maybe this person needs a reminder to to take their insulin or to check their blood sugar. Really, the possibilities are only limited by your imagination here. Or maybe the person says, "You do need to call your doctor, but you don't need to run out to the emergency room for this problem." And that could ease some of the pressure on the emergency rooms.


Dr. Matt Cybulsky: [00:13:48] Teri, I agree with you. I think that Alexa can offer a lot of great moments for access for patients. It can also offer them some peace in getting information about having to take care of themselves in the home when there are questions about that, or even with pediatric cases if there's a toxicology risk or fear of a parent to know very quickly what they need to do for the child. I'm at the American College of Healthcare Executives Conference in Chicago. The opening address this morning was Mara Liasson from NPR, and she's also a Fox News analyst. She was just listing off some things going on in the government right now, particularly with the Trump administration. This is a room full of probably over a thousand or close to 1000 health care administrators in the United States for profit and not for profit. And during that time frame, when she was talking about health care policy, talking about the Trump administration, people got up. They left, they yelled, they screamed. Currently in the United States there's a massive ideological loggerhead when it comes to how it is we view and actually orchestrate and handle caregiving in the United States and health care. It's interesting to hear your perspective, Teri, especially in that blog post about access, because it's a totally different concept from the government leveraging almost all the care in Canada, versus the United States where as a necessity, we might have to move to a private market that offers care through a machine or a tool like an Alexa to handle the growing aged, as well as the shortage of caregivers. In Canada, is there still lots of controversy about how health care has leverage, and do you think Alexa would be sort of the vehicle to calm that?


Dr. Teri Fisher: [00:15:37] So everybody has a basic medical services plan, as it's called in British Columbia, every province has a slightly different name for it. But then you can....your employer may opt in for extended benefits, or you could purchase some extended benefits which would give you the perks about a health care system. If you want a private room when you're you're admitted to hospital, or you want some coverage for physiotherapy, or coverage for prescription glasses. So those sorts of things. There's a base level of healthcare which would cover all the major illnesses that somebody could essentially encounter. But the extra things are things that you could purchase additionally.


Dr. Matt Cybulsky: [00:16:21] Do you think this technology, in light of those things, sort of negates and reduces controversy in the Canadian culture and the Canadian healthcare industry as a result of its existence and maybe its future uses?


Dr. Teri Fisher: [00:16:36] I think that as the technology evolves, it's going to allow access for people regardless of whether or not they have opted into these extended benefits or not. Now time will tell whether or not some of these forms of voice assistants will themselves be some of these additional "pay-for" services that are not covered by the medical services plan. I guess that's going to come back to the government, and it's going to be up to the government to decide as it does with all the different services that are offered, what is considered basic care. And that's going to....while on the one hand . ..


Dr. Matt Cybulsky: [00:17:24] That's going to be a challenge, Teri. That challenge and that notion, because of what the cost savings and the access would be, that's really something.


Dr. Teri Fisher: [00:17:30] Yeah. And that and ultimately that would be a huge, huge shift in what is available. I'm excited about the different possibilities of what the technology can do. But obviously there are a lot of hurdles that are going to have to be overcome for this to really change on a big scale. I just can't think of anything else that I've encountered, at least in my in my career so far, that has as much potential to do that as voice does, at least from what I've learned about it in the last little while.


Dr. Matt Cybulsky: [00:18:09] Today I heard a lecture and the lecturer said the following. He said the reduction of large health care facilities as a result of the advance of technology is a myth. And I sat there thinking about Alexa and voice tech and thought to myself, "I think you're wrong." Given what you know so far and given what you just said about this probably being the one of the more revolutionary things happening in the healthcare industry, especially with how we might use it, if you were sitting on stage with him in front of 200 people and he said, yes, it's overrated that we're going to see a reduction in physical edifices that render care. Would you say he's right? Or would you say, "I think you're wrong."?


Dr. Teri Fisher: [00:19:06] That's a great question. I do think that the voice technology is going to be able to change our current healthcare structure. So I would disagree with him. When I think about the possibilities for this, I let my imagination run wild. And I don't know that....well, first of all, at this stage, we're not talking about these devices doing things where a physician has to have her hands on the patient for surgery. That's where we get into robotics so we can discuss that at some other point. But as far as any type of service that is really based on information and facts and guiding somebody to the right way of doing something....maybe it's healthcare screening through questionnaires, maybe it's having your personal health assistant like you said for an elderly mother, for an elderly patient who's living at home and just needs somebody to talk to in the morning for the sake of not being lonely and being isolated.


Dr. Teri Fisher: There are so many ways that I think we can bring the health service into the home, and the moment you start bringing that health service into the home, then what do you need that service outside of the home for anymore? Sure, there are going to be cases where the person needs to go and see somebody for whatever reason. But as we start to become more and more efficient, and these AI assistants become more and more intelligent, I think, I believe, that it's going to be available in the home. The things that are going to be available in the home are going to be things that you previously did have to go somewhere else but you no longer need to do that. And so I can't see how that would not affect the structure of the healthcare system and the actual facilities that are out there.


Dr. Matt Cybulsky: [00:20:58] Bradley and I, as well as a lot of other fault leaders with voice tech, discuss issues of privacy. There's applications that are really exciting about using voice tech in the outpatient setting and the inpatient setting. You know the seven microphones on average per device. The statistic that Bradley and I heard at The Alexa Conference in Chattanooga was that there will be up to 50 microphones in a house on average in the next ten years. So given the idea that we could record audio and we could record voice that's encoded into words, that becomes fields for pulling regressions later from physicians or even from patients as they speak to their physicians about very private matters. What are your thoughts about privacy and this tool in the home or the inpatient-outpatient setting in Canada? Are there any really clear issues you see already? Maybe there's something unique to Canada that you could share with us.


Dr. Teri Fisher: [00:21:59] I mean, it goes without saying that it is going to be one of the biggest challenges when it comes to healthcare in terms of the privacy safeguards that will definitely need to be put in place in order to protect people's privacy. There's no doubt about that. One of the interesting things that just specific to Canada, to address your question, that I actually learned at this health incubator program that I participated in a couple of weeks ago, and this was one of the engineering and computer science students telling me Amazon has servers in Canada and the United States, whereas Google, for example....and this is third party knowledge. So from what I understand, there aren't any current servers for Google in Canada as of right now. And that creates an interesting dilemma, or an interesting option for health care providers that are going to look at implementing this type of technology, because one of the issues that constantly comes up is where's the information being stored. Is it being stored in Canada or is it being stored somewhere internationally? And my understanding right now is that Amazon is set up to do that within Canada. And so when we went through this exercise in this incubator and we started creating this personal health assistant using Alexa that was one of the questions that we were asked. What about privacy? And the people that I was working with the engineering students and the computer scientists were able to answer that and say, "Look. As far as the privacy goes, one of the critical requirements is that the information needs to be stored in Canada. And right now Amazon allows that." So that may have some bearing on the future and and what services are selected to at least be the first ones to then implement the healthcare technology.


Bradley Metrock: [00:23:45] Interesting. And Teri, I've got one final question for you here. It's made big news here in the United States, that Jeff Bezos, along with Berkshire Hathaway and J.P. Morgan, are looking at creating a new health care venture. In your position as a health care practitioner in Canada, as well as involved with voice technology and specifically Amazon, what are your hopes for what you see Amazon do with this new health care venture, and how do you think it can impact not just healthcare in the United States, but around the world, including not the least of which Canada.


Dr. Teri Fisher: [00:24:28] So that's really exciting. I really hope that this health care venture is going to come to fruition sooner rather than later. I'm very excited that there's this speculation, that this is going on. What I hope they are able to do is come up with a very good system that can address the privacy concerns because again, I think that's going to be one of the absolute biggest hurdles going forward. So the other thing that I'm really hoping for, and this is more of a feature that I think that if these companies could implement would make a huge difference in healthcare, and that's allowing the Skills or the Actions to initiate the conversation with the patient. And obviously, that creates a whole other set of potential problems with Skills.


Dr. Teri Fisher: But you know one of the things that we encountered when we were at this health incubator was that in order for the assistant to be the most useful, the patient or the user would still have to say something to activate the skill and to get the feedback. And when it comes to perhaps reminding somebody to take medication, or reminding them to check their blood sugar or that sort of thing, it would be really great if there was a way that these skills could be designed, with the user's permission, to actually initiate the dialogue and initiate the healthcare. Maybe it's checking in on their mood, or checking in on how they slept the night before, checking in "Did you do your exercise today?" And I think that if that aspect of health care was implemented within this initiative of what hopefully these companies are doing, that I think could be extremely powerful and open a lot of doors, more doors and more quickly to provide better care for the patients.


Dr. Matt Cybulsky: [00:26:18] I've got two really important questions. Is it true that Canadians love Tim Hortons, and secondly, which NHL team is going to be worth their salt coming up in the next season?


Dr. Teri Fisher: [00:26:29] Oh geez that's....well, the first one's easy. Everybody loves Tim Hortons. That's where I take my son just about after every hockey practice with a couple of his friends to go in and grab some breakfast. And number two, that's a sore spot here right now because the Vancouver Canucks aren't doing so well. I'm still a die-hard Canucks fan so I'm keep hoping that they can turn things around. But I think they got a couple of years before getting there. Toronto, our arch-enemy, seems to be doing well so I wouldn't count out Toronto this year.


Bradley Metrock: [00:27:01] We don't want to hear about any of that. We're all about the Nashville Predators.


Dr. Teri Fisher: [00:27:09] Oh boy, Nashville is great. I was down in Nashville not too long ago. I had a great time.


Bradley Metrock: [00:27:13] Excellent. Yes, it's a good place, and Nashville Predators, everybody is excited. We lost a couple of games here lately but we're ready for a lengthy playoff run and bringing home the Stanley Cup.


Dr. Matt Cybulsky: [00:27:26] We need to have Dr. Teri down to Nashville for a Predators game and then the day before or the day after we need to sketch out some plans to go meet with the BC province and the Alberta province to bring Alexa to the citizens of Canada.


Dr. Teri Fisher: [00:27:42] There you go. I'll say one more thing here and that's just when I look at everything that's being done in the States with healthcare and voice-first technology, boy, it's impressive. And as I wrote in my article, just bring it back to that I suppose, Canada is already falling behind. And like I said, part of that is just because some of the technology just isn't available here as quickly as it is available in the United States. But boy it's really exciting when I look down there and I see the kind of things that are going on and I just hope that you know that stuff can can start to be developed here because it's really exciting.


Dr. Matt Cybulsky: [00:28:21] Teri, I speak for Bradley when I say it was a very great show. I really enjoyed the camaraderie with you and sharing with you tonight.


Bradley Metrock: [00:28:29] Yeah, thank you for joining us Teri. Thank you for being so generous with your time.


Dr. Teri Fisher: [00:28:33] My pleasure. Anytime. I'm happy to chat with you guys.


Bradley Metrock: [00:28:37] We will include the article that we've talked about on this show in the show notes, we will include the Alexa in Canada link in the show notes, both to the website and to the podcast as well. We will also include a link to ACHE, the American College of Healthcare Executives in the show notes too. For The Voice of Healthcare, thank you for listening. And until next time.

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