Buildingthedigitalhospitalofthefuture

Ghalib Hafiz

We have started a series of podcasts that are meant to be an inspiring conversation about what we're building at Novacare. Today's topic is on technology. It's about demystifying a little bit how we're thinking about technology differently. And what it means for our clinicians, our patients, and the broader ecosystem.

The purpose of this podcast series is to cover different topics such as technology quality and safety, nursing, our culture and values. We'll go into the site and also obviously cover design, engineering, and architecture. And we believe that this is one of the most exciting things that is happening in healthcare in Pakistan. We want to radiate some of this excitement to some of our listeners and, in the process, hopefully create a bit of FOMO. Fear of missing out. and invite some of the folks that are out there to become part of our journey, become part of our story.

Before we start, this is not the easiest of media to produce. In fact, in terms of effort to reward ratio, this is probably one of the hardest things that we could be doing. So a big shout out to our colleagues who helped set this up and prepare this, especially Sikandar Hayat, who's behind the camera right now. Among his five other responsibilities at Novacare, he also manages a lot of our digital and social media magic. We are ever grateful to Sikander for helping us set this up and especially for the big, heavy lift that is required in post-production. Now let's jump into it.

Normally, at least I find it awkward to introduce myself. So what I suggest is that we introduce the person to the right. So I will introduce Mustafa, Mustafa introduce Zahid Saab and vice versa. So let me start by introducing Mustafa.

Mustafa is a Wapistani. He spent almost 15 to 20 years in the U. S. in healthcare and in healthcare technology. Specifically, he puts the 'epic' in 'epic' … so before 'epic' became 'epic', Mustafa was part of 'epic' and was also involved in healthcare technology consulting at Nordic Health and KPMG. And most recently at CVS Health after their acquisition of Aetna. Designing value-based care programs after that acquisition. Two and a half years ago, he made the decision to return to Pakistan and was with the Agha Khan University Hospital in Karachi.

And we're very fortunate that we were somehow able to inspire him and convince him to join us here. Mustafa has been instrumental in setting up our technology team and our technology function, and continues to lead and drive the vision that we are building here.

Mustafa Hassan

Thank you. It's great to be here and excited for our inaugural podcast.

Ghalib Hafiz

Yeah. You want to go ahead and introduce Zahid

Mustafa Hassan

All right. Zahid is... A person that's difficult to introduce. I mean, he is a renaissance man. He is, a technology extraordinaire. brings an incredible amount of very, very deep healthcare experience, but not just from a technology perspective. How hospitals tick, he knows how hospitals work, how do you put people, systems, and processes together, and an ability, sort of, that's one of the most remarkable abilities I've seen for somebody … who can be extremely aspirational and think of big, bold, wild, and sometimes crazy ideas, but with an incredible focus on the day-to-day execution, down to the minutiae level of detail.

And, you know, we've been on this journey together for well over a year now. It's been a lot of fun. We've had a lot of fun. We've traveled to quite a few places together. Zahids been a keynote speaker at... very substantial, significant conferences. He's an active member of HIMSS, which is the global healthcare technology body. He's written... guidelines on interoperability. He's … published work on, how new care models are defining in new ways of care delivery. So, … but formally he works as our CIO. So it's been a lot of fun working with Zahid and I'm really excited about our journey ahead.

Zahid Ali

Yeah, thanks for the introduction and having me over here. So one of the exciting parts in this entire journey, I just had made a LinkedIn announcement yesterday, and got a lot of messages from the people who wanted to work, who want to help Novacare. So that's an exciting part.

Now I've moved to an introduction. With the other way, so I used to say him “bhai” because this is how we have built a relationship. That's really like a brother, actually. Uh, so roughly one and a half year ago, we met together at a coffee shop. And we had a bit of a small conversation. I thought that I would never work in a corporate environment again, for many many reasons, especially in Pakistan … [but] when I met with these guys, Mustafa and Faraz, that took me a lot of interest.

And, uh... Within all this journey of one and a half year, So I always used to say, if you need to see a crazy person, who is always up to work, doing a lot of stuff, very detailed oriented, so you can meet Ghalib bhai. So, and his ex-McKinsey … spent a lot of time in healthcare …. doing the transaction structuring, optimizations, and few mergers and acquisitions so he brings that kind of knowledge that really uplifts the institution … the best part that I have seen about him ... He involves in too much detail. He studies. He finds the best. outcomes of any process and even to me, who understands technology very briefly, alot of learning, a lot of aspirations I gained from Ghalib. So this is Ghalib.

Ghalib Hafiz

All right, thank you. Uh, thank you guys. That was … heartwarming, very wholesome.

Okay, let me start by framing the first question a bit provocatively. Which is, we know the health system in Pakistan. There is no healthcare documentation. For obvious reasons. We all understand the reasons. People don't like to document. In systems where there is documentation. Technology is the number one driver of burnout. So these systems that are out there are literally driving all the clinicians crazy. And it seems paradoxical that we would build a system, with so much technology in it that is both, what nobody else is doing. And actually, potentially, an HR issue. So, what are we doing? Seems paradoxical. Why are we making such a big strategic mistake?

Mustafa Hassan

Look, there's a lot to unpack here.

I think... The issue around documentation and people not documenting, I think it's not just pervasive in healthcare. I think it's generally pervasive across the board. Healthcare happens to be one of those industries in Pakistan that is relatively nascent, at least in the private sector, and you see the same kinds of negative behaviors manifesting. themselves here. But yeah, you're very right to say that, even in much more advanced economies where substantial investment in healthcare technology has gone into healthcare systems, that has often produced a substantial amount of clinician burnout. And I think there's been a lot of chatter around it. Which... Rightly raises the question of, you know, why are we so gung-ho about technology.

I think one of the things to realize right is that technology has advanced incredibly fast in healthcare over the last decade or so, and one of the biggest areas of advancements that's happened is the ability, uh, standards around which you can exchange data so that even if you have multiple systems in place, one is taking your registration data, one is taking your clinical data, another one is taking your financial data, to be able to connect those systems together and make them work seamlessly, often in the background, in the context of a you know administrative workflow or a clinical workflow. Has become a lot easier to do now, but you need to be able to think about all of these things up front and how the various puzzle pieces are going to fit together.

To make healthcare seamless. So, but if you are able to do that, what you unlock is something that is just magical, right? Like it should work like magic. You know, you're an overwhelmed clinician going through their day. Technology will quietly in the background just make sure that you get the right information at the right time to be able to make sound decisions. About a patient or even as a patient when you're walking into a healthcare facility, technology, if done right, can really simplify your experience and provide you transparency and visibility into what to expect. And it's not about having flashy screens or fancy gadgets or technical-looking devices. I think the best-done technology just works seamlessly in the background without you even realizing it.

And that's why I use the word 'magic,' because you don't know what's going on. And if we do technology right... We will build an institution where everything just seems to connect harmoniously together and takes a lot of the friction out of the process so that our clinicians are focused on providing the care and our patients are focused on receiving the care for themselves and their loved ones. So that's what makes me excited about this journey, and I think that's really central to... our strategic investments in technology that we've done.

Zahid Ali

Yep. So basically, I agree to what Mustafa has alluded to. So.... We need to compare healthcare industry with the rest of the industries. Thank you…. so maybe we take example of a airline industry we take an example of production industry.

The one complex part in healthcare, it has so many facets, so many areas of work. That the complexity is huge. But over the years, healthcare has not really transformed. Like, we keep on... building new things, putting more pressure on the people, especially the providers, the clinicians, the nurses, that you have to do this. If something is not happening in terms of the quality, in terms of the outcome, we always put more pressure on the providers. So that's a kind of a negative aura that has been set in place for the last many, many years. So what opportunity this, obviously with Novacare, it brings, we are a green field. We can get out of that stereotypes. We can build a better experience. This is what we are trying to do.

This is the investment we are making. Not a very stereotype, maybe a kind of EHR system where even to record one patient's proper documentation on all those different standards. You need 15 to 20 minutes so if we are taking 15 to 20 minutes of one episode of patient-doctor interaction just putting the data into the system. So then the patient care is something that would be missing in the entire journey. So that's, I always used to say, Healthcare is relational. So it's not a transactional. So, the transaction is a byproduct. You need to build a relation between the provider and the patient, even the care facility and the patient. So, that's something that we are thinking through. And how we have to provide them the right kind of navigation, the right kind of experience coming to the hospital.

In the hospital and after the hospital. So, roughly, like in the lifespan of a person. So, about 70% of their time into the entire lifetime journey is spent in the outpatient setting. 30% is spent in the inpatient setting. So, if we just take like rough numbers from different studies or the data published. Coming into the health care facility and going out of the health care facility, check-in to check-out time is usually three to four hours. So in this era, ... especially the busy professionals. like executives and even ordinary people. The life has changed totally. So, nobody wants to wait into the healthcare. If you go to the hotel, so they wanted to use customers to use the table till the time they are eating, they are using it.

They don't want you to sit over there for a long time, except the coffee shops. So. You see, in healthcare, it's reverse in a way. A lot of people are sitting, maybe four hours if one person is sitting over there. So we can calculate how much facility is used, how much facility is occupied. This is why the hospitals are known to be upgrading machines. That's something that we are trying to break. And we would build an experience, we would build that experience with the patient, with the help of the patient, with the help of the providers. So we are building a true quad-helix model. Where we are involving the innovators, where we are involving the providers, where we are involving the patients, and where we are involving our tech teams.

So that's a kind of, I would say, a recipe that we are building and all this investment. Would bring benefits to the community at large.

Ghalib Hafiz

All right. No, I just want to add strategically, right? What we also see in Pakistan is this care avoidant behavior. Because the healthcare service the product hasn't matured. And that has a huge cost in terms of deferred healthcare. In terms of what happens when the case actually presents itself. To a health facility, the level of acuity, the level of complexity. Just grows significantly more than it should. Let me frame my next question, which is, we've built hospitals or looked at greenfield facilities like this. What's different now? And maybe I'll start with you. Versus just from five to seven years ago? What's fundamentally changed, just in the last five to seven years?

Zahid Ali

So basically, in the last five to seven years, one of the revolutions I would say that's coming very strongly is the patient involvement. So over the past maybe 15, 20 years, we never thought about the patient. Right now, we are thinking about the patient. That's a revolution that's there. We also started thinking about the providers. Like are in burnout. … is it something they can make it easier? And when we start raising that question at the same time, there was technology. That is the AI. So now AI is playing a big role. The healthcare industry is typically considered 20 years behind. Other industries, in terms of the transformation, innovations. So that 20 years journey. Would be covered pretty much with AI. Especially, like, it's uh, many many publications are there. Ninety plus seven percent of healthcare data is never used for any secondary purpose. So one patient's data is another patient's medication. So, if you use it rightly with the help of AI, so we can build that kind of mechanism where actually the care delivery even within this brick and mortar setups and out of the brick and mortar setups. at their homes at their workplaces can be delivered it's like a really a connected care right now people are talking about how to establish that connected care model. It does not require the patient necessarily to come to the hospital. So where they are, they are engaged with their providers. So that's a kind of thinking that is evolving. And for us, that is one of the key driver to put into our design thinking.

Ghalib Hafiz

Yeah, I mean, I would... Add to that and... You know, the last major hospital that I was involved in was 2019 Vintage. and, obviously, this whole user centricity has been around now for two decades. but, when we built the 2019 vintage, technology was very hard. You only got vended solutions. Those vended solutions were expensive. They were hard to integrate seamlessly. So you ended up building something that we were quite proud of, what we built. but it felt like a compromise. And I think these days it's not just what you can build, which has completely changed, but also how you can build it. And I think one of the big differences in this seven-year vintage, it almost feels like a generational leap. The technology seems easy. The integration seems easy. You know, we just wave our hands and say, 'the technology will figure out.' As long as there is a real user need, a real pain point that is being addressed, a real business case, and so on. I think that's one of the joys of this project: we are dreaming up and actually building technology that would have been very, very hard to build.

Mustafa Hassan

Yeah. And, you know, to what Zahid started out with and you're sort of finishing out with is fundamentally, I think, expectations have changed. From a clinician perspective and a patient perspective. The same kind of consumerization that people have experienced in other aspects of their lives, whether it's consuming content, whether it's consuming food, whether it's consuming entertainment or anything else, they're expecting no different in healthcare now.

And I think now that you're designing something, you have to intensely think about that patient and clinician at the center of it and what they expect. And yeah, the other two things, totally, right? Like interoperability standards, I think, have stabilized. So you can exchange most data with most things in fairly standard ways. Plus, you know... I think cloud is a lot more mature now, right? The computational power and the economies of scale that you can get there, coupled with AI readiness. I think that's sort of a paradigm shift. I think the way I would sort of summarize it is: five, ten years ago, technology was optional. Um... But today it's foundational. And you can't live without it. You can't do without it.

Ghalib Hafiz

So , just to dig a bit deeper, I mean, I think we've talked about a few examples. But can we talk about one or two real examples about how technology is relevant? Either for a clinician to help them make a clinical decision or for patients to experience this hospital. And experience the quality and safety that this hospital promises to deliver.

Zahid Ali

Yeah. So like, typically when we. The patient comes to a clinic, doctor sees the patient, do a kind of bit of greetings. Then he needs to see all the information was efficient. So what happens there is a kind of a long list of many many items, maybe 30, 40, or different touch points you need to see what medication patient is on, what kind of allergies patient has, what is the past family history, social history, so many different things. Then he needs to establish in his mind what is the problem the patient is facing actually. So all that process is usually like four to five minutes. If they go really into [into] the so many clicks are involved or maybe a navigation is wrong, one way of doing that is building a digital twin where it summarizes all that information with the help of AI. And the doctor can just read the summary of the information. He does not need to go to tens of different lab reports, maybe radiology or medical imaging that's there. And he would be lost. So those are the kind of few facilitations that are essential in today's Uh, time. and The second step, when we talk about the provider experience, they need to create a nodes, actually.

So, if it is templatized, their work would be very easy. Maybe they would spend 70 percent less time than maybe making sections or tapping into those all those cranky boxes. So, another level of maybe ease for the provider is basically ambient listening. And that's a very famous topic with Mustafa. He loves it for all the practical reasons because he understands what it would bring to the providers. So, with that, like uh, they can record the conversation between the patient and the doctor and automatically a note would be created. So, the only part is just synchronization of the doctor, provider, and the patient with these gadgets. And now, with the time, these gadgets are really getting more and more intelligent. So typically, uh, like that, 10 to 15 minutes time of provider in making the notes. Not really can be sharpened into two or three minutes. He only needs to review, he does not need to write all those things. Especially right now, initially, we used to type the letters. Uh, it might have taken us 30 minutes. Some old people would take two hours to write a letter. So now, with the help of AI, you just give it a prompt. It will create a letter for you. And then you just need to proofread it.

Mustafa Hassan

Yeah. But you know, and so on the outpatient side, there's so much efficiency to be gained in terms of the number of patients you can see and how well you can see them. But like, even on the inpatient side, where a lot of the complexity happens, I mean, just let's just talk through a couple of examples.

It's two in the morning, and a patient, you know, shows up to the emergency room, right? They're confused. They're short of breath. They don't clearly remember their own medical history. And there's a physician sitting in front of them trying to understand what's going on and you know, what to do. For this clinician, now, to have a single view of the patient's past medical record, of the labs that were done, of all the images, the clinician having a view of the allergies that somebody has, etc. Right all in one place and not just having all the information in a place, but intelligent automation in the background looking at all of this data and telling the clinician that, if they're prescribing a medication that may have an adverse interaction with something that the patient already has, and then flagging this for the clinician to review and adjust their decision course. Something like this, you know, can really prevent a catastrophic outcome where you have proactively solved the problem by not prescribing a certain med or a certain dose and changing course, right? So then you don't have to react and fix the patient that's already ill.

Or another case, like there's a you know elderly patient you know gets admitted for pneumonia and has impaired sort of kidney function and over the course of that hospitalization, you know, many medications are given, they're on fluids. Every 12 hours, their care team shift changes. When new people come in, they need to understand what's going on with the patient. And, you know, imagine that, through the course of this hospitalization, this patient is getting a certain dose to manage their kidney function, right? But since their condition deteriorated, that is indicated by the lab results. Now, the dose that you gave yesterday is no longer safe. The system knows that, you know, the dose is no longer safe. And if you come in and prescribe that dose tomorrow in your shift, you'll get an alert. And you'll have an opportunity to, you know, do something differently. Otherwise, and if you don't have these intelligent systems, what happens, right? You go ahead with that dose. It can lead to, you know, further impairment of the kidney function, internal bleeding, the patient crashes. So, like we talked about earlier, these are the kinds of things you can now do if technology works seamlessly together in the background. And, you know, that is what drives, I think, our collective excitement in what we can do at Novacare in Pakistan.

Ghalib Hafiz

So I've got a follow-up question. Two or three, actually.

Zahid Ali

I think even I should ask you a question. Okay, so basically, now we are talking about some real-time examples. So in your view, like, how the patients want to consume healthcare today, versus they wanted to consume five years behind. and how we rationally are thinking on those particular points where the patient how patient wanted to consume and how do you see the impacts once like it's it's a philosophical discussion right now but actually when we would be practically opening up hospital In Shallah in end of September so how do you see all that visually in your mind coming from a McKinsey background where you can do all the stuff with the numbers.

Ghalib Hafiz

Yeah, look, I think for the patient, so... The patient has become very, very used to having a lot of information and a lot of transparency. in their consumer experience. um this has happened across industries you know 10 years ago when we had to order a cab. um you know you stand outside on the road and you hope somebody's passing by. Now you order a cab, you know exactly how many minutes it's away. … what the you know which route they're taking what the driver's rating is and so on and so forth they expect that same level of information and transparency in healthcare which is I have to discover what type of care I require. … that will all be assisted by technology you know whether it's uh generative AI or some kind of agent or bot in the background assisting them with the differential diagnosis before they enter the healthcare facility. in booking their appointment, again, people have become less patient with the traditional model. of you ring a contact center. Um and have that long discussion now you know it's all, click through, you know, straight through processing. So, you know, you book your appointment, there is complete transparency in terms of who you're seeing, what their background is, where you need to park in the hospital, where the parking is going to be available. I mean, we're investing in a parking management system. The wayfinding to the facility. We've talked about queue management today. I mean, one of the most painful things in a hospital. Is actually waiting. I mean, this is one of the things that you do. And for some reason, no matter how good the hospital is or in which part of the world the hospital is, at least what I've experienced as a patient, is you wait. And you don't know how long you have to wait and why you're waiting.

Mustafa Hassan

That's the agonizing part, right? Is it going to be five minutes? Is it going to be 50?

Ghalib Hafiz

And nobody can tell you.

Mustafa Hassan

Nobody can tell you.

Ghalib Hafiz

Right? So technology can actually work to set those expectations around. Why are you waiting? How long do you need to wait? And then, again, that's the part of the consumer journey, you know, where waiting is not the biggest pain point. The biggest pain point is when you show up to a clinic or a hospital. Um, it's usually because something could be wrong. Um and you know, managing the emotions around that, around the health and well-being of yourself or of a loved one. Being in the care of not only a team that demonstrates that a human connection and that empathy, but that understanding, as you described, Mustafa, that there are a number of systems working in the background that are ensuring that the decisions that are being taken in the next step of a patient. Um, are informed by, you know, the best of what's out there in terms of decision support, in terms of pattern recognition and so on, that just eases to some extent a burden that exists when you access healthcare. And this is a game changer because if you know that this is the highest quality, the safest hospital, and that technology is working to deliver that quality and safety. Um, that is worth you know gold.

Zahid Ali

So one of the touch points, like in two different studies. So, whenever we talk about the optimizations, we always talk about billing optimization and revenue cycle management. So, 36% of the cost in healthcare settings is really about the patient journey, patient experience, patient registration. So, nobody thinks about all these optimizations. and one of the touch points that we are doing a kind of very rigorous design thinking, and we have one our maybe one of the many series of the workshops about the design thinking of the experience. So, if any health facility in the world reduces the waiting time, they can optimize their revenues and they can deliver the better care and with more predictability. So that brings a lot of like dollar value in terms of from a bigger point of view.

Mustafa Hassan

It's an important point to be made around waste, you know, and I know you're very passionate about this particular subject in that there's a lot of waste that happens. Whether you have a simultaneous overstock and stock out problem, not having visibility into your supply chain, etc. And, um, the same fundamental concepts that we're talking about here. Um, on the clinical side, connected systems, data, transparency. I feel like substantially help us run a better hospital administratively as well, right?

Ghalib Hafiz

No, I mean, on waste, one of my favorite examples, which you guys know about, is... Where is the equipment? Finding the equipment. Again, it's human nature. When equipment is constrained, when it's in short supply, you hide it in nooks and crannies and in cabinets and so on.

Um and again, I mean, this [RTLS: Real Time Location Services] is one of many systems that we are deploying here at Novacare, but the ability to track that equipment, the ability to understand what its utilization is, etc. Um, you know, allows you to reduce uh uh, you know, both uh, the amount of capex you put in, but also the time providers are spending on just redundant tasks like you know, finding an infusion pump or finding a ventilator.

Zahid Ali

Yep. So, obviously, one touch point I would like to give for the people who are listening to this podcast. So, right now, like everybody talks about the technology. So, really doing it is a bit different, you need to invest in that. So, over here, right now, within Novacare, we are roughly about 50 people. And out of that 50, the biggest team is the IT team. We are nine people in IT. So essentially, 20 percent of the entire staff right now is acting this is a kind of focus energy that we are putting together. Other than, obviously, all... as a teamwork, so it's phenomenal. Even, uh... having all these design thinking hours and even to what we are spending in EHR, what we are spending in ERP. So far we have crossed 5,000 hours collectively spent on all these design thinking and executions.

Ghalib Hafiz

Okay guys, so one of the things that I'm hearing from you is that technology is going to do a lot of the heavy lifting in terms of driving care in terms of making the decisions, flagging issues, etc. Um, and, you know, we know that algorithms can do a very good job. So if technology is doing all that heavy lifting, what are the providers doing? What are the physicians and nurses and technicians up to?

Zahid Ali

Yeah. So, in order to answer this question, we need to understand the health care problems right now. All over the world, there is a huge shortage of providers. There is acute shortage of nurses. The way the populations are growing. we are not producing. those people. I think the most effective Uh... industry in the world is basically healthcare industry because we are not producing that kind of people. And why that technique? Because people are getting more from other industries, not being a doctor. There was a myth, maybe 20 years back. Either you become a pilot, either you become an engineer, or either you become a doctor. Then you make a lot of money. So that's not very true in healthcare, especially. You had to burn yourself to make a lot of sense of it. Bye-bye. So what? The relational aspect of healthcare is a very strong aspect. And, uh... What is technology? would make the providers to do. To focus on real health category, not pretty much focus on technology for the sake of technology. Like making, uh, maybe two pages of medical record, typing all that. That era is gone; we need to provide them assistance where these two pages medical record is made in 30 seconds. They just need one minute to review that medical record.

Even the review happens in a way they are assisted to make very specific touch points, like where they need to review. They should only review those things. These are the systems that these this technology would bring to them, especially when we talk about initially, like if you talk the example of the nurse. She needs to take vitals of the patient. She would take the vitals, she would put the machine. and what would happen so after she would see on on maybe this uh a view of the machine. So she would put that into the system. There could be typo mistake. There could be many issues. So with the integration, this puzzle is solved very well. So now, if you talk about maybe IoT devices that are connected to the patient, So with those IoT devices, it's a real-time. You can track all those things as it is happening. So if there is some critical you can create alerts. and even than us. who is associated with the patient. would know where the problem is happening. You see, we all have old

Ghalib Hafiz

But is there a danger that the nurse now stops paying attention? Because before she was, or he was responsible for... flagging abnormalities, etc. Now you're reliant on the system. And, uh, I don't know how many folks in our audience would understand the term hallucination. When it comes to AI. So my question is, again, what is the provider really doing? And maybe, Mustafa, you can explain what a hallucination is and why we worry about it in the context of healthcare technology for maybe my grandmother who's listening to this for no other reason other than the fact that I'm her grandson.

Mustafa Hassan

I'm sure she's damn proud of you. Um, so the idea of hallucinations really started getting a lot of press with the advent of AI and particularly generative AI. And generative AI is technology in essence that creates content and interpretations for you. Rather than just algorithms that would summarize results and output data. Gen AI takes that leap forward and starts putting its own interpretations. Um, The challenge of hallucinations is that sometimes AI, you know, starts making stuff up that may not actually have any, you know, basis in reality. And, you know, if you're researching the best restaurants or what's the best prank you can pull on your kids, et cetera, you let go. But if you're making a decision about how to what kind of treatment to prescribe to a patient who may be critically ill, it can have catastrophic consequences.

I think the issue of hallucinations in healthcare, particularly with the use of generative AI, are real. And I think there's a whole conversation to... we had around, you know, the ethics of AI and the governance of AI that I know Zahid has, you know, quite a nuanced perspective and you may have actually written. about it as well so I think you know that's a challenge right that it's a known challenge it's a known challenge in the same way that you know with self-driving cars there's a known challenge of you know the ethical dilemma of you know what does the car do or when does you know self-driving misfire or stop working you know you can cause a lot of harm Right. So I think. With the adoption of cutting-edge technology, there are edge cases that have to be dealt with in a responsible way. Ghalib, going back to the earlier question around if technology is making these decisions, then what are clinicians doing? I think technologies should not be making the decisions. Decisions need to be made. They need to be made. with incomplete information. With limited time and limited resources, and in that moment, regardless of what decision you're making, you want the best interpretation, the best analysis available to you at your fingertips. That is what I see as the role of technology in healthcare: it's equipping the decision maker with the best information available at that point in time, so that they eventually hold the pen on what kind of decisions they want to make.

Zahid Ali

Very valid point. So, like... doctors are humans. So they can make mistakes. See, if, like... there is anything that is left over by any reason. Because they are human, they cannot they might be something to read out into the medical record if it is there]. Usually, in Pakistani context, we don't have the medical record in most of the cases. So we can imagine how much mistakes or how much errors would be there, although we don't have any quantification for that. But you see, when... these tools like AI or maybe some of the algorithms. They can exactly guide the doctor. This is the important consultation that you need to take care of that. So that always helps, especially when we talk about the right dosage, right medication, and the patient might have some allergies in the past with one of the medications. … and maybe two medications had a kind of similar sort, so the their daily dosage could increase and that could be detrimental to the patient. It can affect their kidneys. So, those kinds of knowledge base for someone to keep all the time into mind. It's not possible. I mean, it's not possible. So these tools would definitely help these doctors to make the right decision, but actually, the decision is to be made by the doctor.

Ghalib Hafiz

So, can I synthesize this as... Doctors are humans. We know humans make mistakes. We have limited cognitive and memory power. Of course, we discussed that systems make mistakes also, they can hallucinate and so on. But if you put the doctor and the system together, and you make the doctor in charge of the system. You know, that's as good as it gets. Is that fair?

Mustafa Hassan

Yeah, super intelligence.

Ghalib Hafiz

Yep. All right. We talked about ambient listening before, but again, for my grandmother, who I think a lot of our audience would know what ambient listening is. But just for, I know you're very, very excited about this. And we don't have a lot of examples of ambient listening in Pakistan. What is ambient listening? What are we doing?

Mustafa Hassan

Yeah, I mean the fundamental concept of ambient listening is there's a recording device that is listening to a conversation between a patient and a physician. Or any two people. Um, and the concept, and then, you know, it's able to capture that conversation, summarize and synthesize it. And then create a clinically relevant note out of it.

Um, Fundamentally, the concept has been around for some time, but now the kind of wide-scale application that we're seeing in the medical world, that's the piece that's exciting to me. And the way it will work is... In current state, even when you have all kinds of systems in place, it's a very documentation-heavy process for somebody to interact with the patient. And oftentimes it takes away from you know, the patient-provider relationship, where you know, you're sitting across from your physician, you're explaining something, and they are busy looking into a screen, asking you questions and typing. That's not the way humans interact. You have to make eye contact, right? You have to build that sense of empathy. Ambient listening does away with this problem of looking into screens and typing.

And the way we envision patient physician encounters working in the future is somebody will walk in and the physician will have a proper conversation with that person and then the ambient listening devices will record the conversation, summarize them in the form of a clinical note, put that clinical note in the electronic health record system that you know we're using, and then those can, after the physician reviews that note, be easily just get filed into the patient's record with a click of the button. We'll take it one step further. When the patient leaves the appointment, they're going to get a notification on their app that this is what you talked about in your appointment. Here's the diagnosis you showed up with. Here's the treatment plan. Here are the medications you need to take.

And here's when you need to have a follow-up appointment. Now, that kind of continuity and transparency and visibility that we can provide while creating a very natural human interaction between patients and physicians can go a really long way in creating the kind of healthcare delivery model that we're looking to have with Novocare.

Zahid Ali

So, maybe one question, rather for you, so if we have two parameters: convenience and the cost. Where would you go first?

Ghalib Hafiz

As a patient?

Zahid Ali

As a patient.

Ghalib Hafiz

Well, it... It depends. I mean, I think... Generally speaking, in healthcare, you would go for convenience. Um,

Zahid Ali

And all the quality parameters are there, so you would go for the... Yes, that's right.

Ghalib Hafiz

So and I mean, I think the This is one of those sectors or industries in which, you know, again, people's well-being and health is at stake so um actually lower cost signals that there is an issue with the product. or the service so um so

Zahid Ali

Have you ever in your lifetime experience have you ever encountered any parameter that gives a kind of ROI to patient.

Ghalib Hafiz

In what sense?

Zahid Ali

Like, if I'm the patient, I need to see, usually businesses do their ROI. It's kind of, you invest something, and then you have the ROI. So do you think? Like, is there any anything in the past that you have encountered in terms of patient scoring? They can do their own calculations or with the care delivery? Or maybe that's our design thinking, we should just go deep.

Ghalib Hafiz

Yeah, no, I mean, I think it's a very interesting question that we think about a lot, which is... we have this service or this product. That we, from the inside, know how much better it is for the patient. But how you explain that to the patient? Uh, and their understanding of it. I mean, and this is not just in the technology domain. It's across domains. The investments that we're making in small aspects of the building, you know, when it comes to safety and infection control and so on. A lot of that is just not visible to patients. … I think when we speak to patients, they generally know that if you go walk into a hospital, … you may walk in with one ailment, but then acquire an infection or some other ailment from the hospital. So we generally have to avoid hospitals. But I think this is one of the challenges that we'll have with introducing a trailblazing product or a service like Novacare breaking down. You know, if we're putting a UV disinfection system on the handrails across our staircases and our escalators, a little sticker saying, 'You know, this is there for your safety and to reduce infections, and so on.' That is something that we'll have to do across the care journey, and to create a consumer that is more discerning. So they understand that when they are getting a Novacare product or a Novacare service, um every aspect of of that product or that service is optimized, you know, to their benefit.

Zahid Ali

Yeah, so it's like really building a kind of a trust for the patients or maybe any of the people who are coming to the hospital. It could be a patient, it could be some family members coming too. With them. ou.

Ghalib Hafiz

Right, let's uh switch gears to EMRAAM … HIMSS ... what does HIMSS stand for?

Zahid Ali

Health Information Management System Society.

Ghalib Hafiz

Okay, so HIMSS is the international uh body that sets standards and in a way governs health information management. They have a standard called EMRAAM. Um, and EMRAAM goes from stages 0 all the way to 7. And at Novacare, we've set the aspiration that we want to achieve HIMSS Stage 7. Um, how many hospitals in the region are at HIMSS stage 6 or 7?

Mustafa Hassan

I believe in South Asia. Zero at seven in South Asia. Um, in the region, if you look at the Middle East, you know, now you have the likes of Cleveland Clinic in Abu Dhabi or some of the Sulaiman al-Habib hospitals that have recently, you know, advanced to that level of digital maturity. Five or ten years ago, you would only see these in the United States, you know, the likes of Stanford and Mayo Clinic. etc. But I think, you know, now you see a mushrooming of these advanced, digitally advanced hospitals in our region, as well as, you know, Southeast Asia, Korea, etc. But it's still a very, very coveted place to be if you're qualified as Stage 6 or 7.

Ghalib Hafiz

And I think Zahid Sahib, you're involved in setting some of these standards and the governance, and so on. What does it mean to be HIMSS EMRAAM Stage 7, which is something that we aspire to at Novacare?

Zahid Ali

So basically, when we talk about technology, when we talk about quality, there has to be some benchmarks. So basically, HIMSS Stage 6 or Stage 7 or those benchmarks. So, as a patient, like, we need to give them the confidence that we are taking care of the right process, the right quality is there, the safety is there. So that's something that is ensured by all these standards. So, like, we talk a lot about the technology. Where is the validation? So validation comes with the help. So they, hence, basically guide us how to do the medications, how to do the nodes, and how to do the integration. So there are many many areas that set apart from the technology, but hence, make sure that you are following the standard guidelines and protocols. On a different note, we are doing a similar thing in many, many other areas with the JCI.

With certain quality standards, like with edge certification, green LEED, yeah, and then especially, like, all these would build a trust for the patient and even our providers would follow certain standards, especially affiliation with the Imperial. We can see the sign board just behind me, if somebody can see. So... like that adds another layer of trust that we are following the like Best protocol. To provide the right care to the patients.

Ghalib Hafiz

And to what extent is EMRAAM Stage 7 about the system versus about the process and the administrative discipline? And so on.

Zahid Ali

So, basically, it like covers all these different domains. So, I would say talking about the clinical. It covers the most. Technology is talks more about it, like maybe the downtime procedure, backup, recovery, and focuses more on the integration. How these systems could talk to each other when we talk about the antimicrobial processes. It dictates a process as well, like how you have to do the closed-loop medication. Or you need to record different parameters. Uh, within the system, into the patient medical record, so those are uh different uh touch points where HIMSS guide us. So, mostly, I would say 50 percent more than 50 percent, are the clinical. So, usually, it could be a myth, like it's when we talk about health information, it's about technology, it's more about application of technology to deliver the right outcomes.

Ghalib Hafiz

Yep. No, I mean, I think just to... synthesize it or to state it differently, the technology is just a tool. It's a... much, much more about the people and the process. So you can have fantastic technology, and still not be at stage six or stage seven.

Mustafa Hassan

And that's the key thing, right? You can't buy your way into it. You can't just go and spend a bunch of money buying expensive systems and expect to have a high level of digital maturity. You've got to do the hard work of... Yes, you need to have the technology, but more importantly, you've got to have the clinical processes and you need to have the governance to make these processes work around outcomes. I mean, one, you know, a couple of examples, right? Like this closed loop medication administration. requires there to be no manual inputs from the time that a drug is prescribed to the time that the drug is administered to a patient, right?

Being able to define this process and then train your entire clinical staff to follow it. Consistently every single time requires a lot of organizational maturity. Right, same with you know using data to you know having to create risk scores for patients to drive outcomes. Right, um, it's not about having systems. It's like, if you're not putting data into the systems, then what are they going to tell you? Or, having all of your orders placed into the system. Right, like that means you have to train all of your physicians to make sure that they are logging all of their orders into the system in a certain way. So that requires a Herculean sort of training and change. Management and physician engagement effort.

It requires you to design things in a way that is friendly to clinicians, otherwise they're going to stop using it. It requires to have a governance that says that if somebody is refusing to do it, then there has to be a mechanism to coach them or manage them, right? And these are the hard things that you can't just buy your way into. And I think that's where this framework becomes really effective.

Ghalib Hafiz

Yeah. I mean ... clinicians refusing to use the system. That's a familiar problem. Okay. Let's talk finally about I know Zayed Saab, you're quite excited about what we're doing at Novacare in terms of innovation, incubation. and user-centered design. And we, uh, there are a number of systems that we're looking to design, you know, like our patient infotainment system, RTLS, real-time location services, and so on. So tell us a little bit about what we intend to do.

Zahid Ali

Yeah, so... thank you. Right now, technology is not an issue, actually. Technology is everywhere, with all these cloud providers, with AI. So technology is there. The only problem is application of technology to get the right process, to get the right outcome. So, and over the years, healthcare industry, especially this hospital industry, has been a consumer industry. So what would happen, like most of the time? The big companies will come to you, understand the problem from you. Then they build a solution for you. do a pilot with you and then they would sell it to you. They would sell it to the rest of the world. But the origination of the problem is the hospital. Where the problem is really happening.

So then they come up with the solution and you always become a consumer. In Novacare, we don't want to be a consumer. For many many things, for everything. Many of things we would be a consumer where we cannot. Do many things, we are just getting the vended solution. But for all the small things where we wanted to build the right experience, we wanted to give. For example, quality of care to the patient and we wanted to bring accountability and traceability. So, in few areas we don't have much of liberty to have the systems. So, over there, like one of the establishments, for this to do a kind of innovations, design thinking. So far, just to talk about a few statistics, we have six design thinking workshops that we have done.

The first workshop that we started was pretty much on digital front door or the patient experience would look like in this digital arena. The second one was pretty much focused about the outcomes. What are different KPIs that we wanted to measure in terms of our operational procedure … How CFO wanted to see things from his perspective, how CEO wanted to see from his perspective. Like, how we can make a better inventory control. So, and now we are putting together a complete philosophy. Where we can build an ecosystem, where we can connect the academia, where we can connect the researchers. And even we can monetize the data for the secondary purposes and this that's a very uh like Uh... close to heart like a topic for Mustafa.

Ghalib Hafiz

Yeah, clinical trials.

Zahid Ali

So, so, so, all these different thinking, and then especially, like Technology, people can only think about the technology. They don't understand emotion. The people, pretty much, so if the people are involved in that, doctors are involved in that, how nurses think, Technology people would not understand that. So we need to talk to them, we need to understand their behaviors, how we can build a convenience for them, maybe, taking, uh, some like, uh, maybe into ICU, nobody can go over there. If the patient is critical or stuff like that. So how technology can help them to reach over there? How they can communicate to patient that's very important, you always need to communicate with the patient, being a provider being a nurse. So. This is a kind of design thinking that we are bringing into the practice.

And on their design thinking. So, we would partner with... different academics, commercial companies. 1 to 2 work with us in that journey to build their products. Ultimately, they would build a very robust product. We would get something out of that in terms of, for example, would solve our problem. And be a part of that journey for greater good.

Ghalib Hafiz

I think to synthesize that, obviously the people at the frontline who see the problems every day. We need to create a culture. Where they can solve those problems with the help of technology. and even within that, we have a very, very high tolerance for innovation and the risk that comes with it. of course, in appropriate domains, but we have a very, very high bias for that and I think that would make this a very, very special place to be.

Zahid Ali

Yeah, and usually, like not always, technology can solve the problem. there might be a bit tweaking in the process. there might be a different way of doing the same thing. that's the innovation.

Mustafa Hassan

And you know, Zahid, I think one of the things that would be good for you to comment on... is the organizational aspect of this. We've talked a lot about how you have to marry technology with process, governance, and people, and clinicians, and end users. As you build, as you think about your role as the CIO, traditionally, when you think CIO, it's a backend ID function. With a bunch of boxes and wires, right? How are you thinking about the organization? And your role relative to your peers. Um, in bringing this technology to life.

Zahid Ali

Yeah. So I will go back into 2022. When me and few other guys set together with HIMSS and start creating a new role actually into the healthcare industry. So that is a chief digital transformation strategy. We built a certification program after the CPE, HIMSS, and CPE. That's a CDHTS. So it took us like roughly three years to build that certification. So now there are roughly maybe more than 100 people who are certified on that standard. Because when we talk about technology, it's not only the technology. Technology has to sit on the process. So the best understanding in healthcare organization about the process ultimately comes to the technology team because they work with the teams they build those processes.

So when they build those processes, they build a collateral. You see what's happening in the world initially all over the world was thought through that a CFO or COO would go up to the ladder to the CEO. No, the myth has changed totally. these technology people are getting to the ladder because they're so detailed. They understand all the processes. From the data, they can accept what's happening over there. So they become better managers. So this is this is our whole shift of change into the healthcare industry that's happening now. And especially, like thinking on the side of innovation, thinking on the side of what AI is bringing, thinking on the side of what cloud computing is bringing, that's essentially our differentiator. And not only thinking about buying something from XYZ.

Building that experience where all these plugs can be ready. So I tend to the care delivery, so that's that's a whole shift from a typical kind of maybe a technology role that's happening over here. And for me, what brought me over here, uh, into Novacare, is whatever we had studied done all these eras. So this is the platform where I can apply all those crazy ideas. And it's the liberty that all of you people have given to me, putting a lot of trust on me. To make things work in a different way. So I had the liberty to uh think differently to bring some new ideas even today, maybe last night. We were talking on the dinner. Is there a way we can think of or maybe offsetting the carbon credits through the care delivery?

Is there a way we can do a kind of data credits for the patients? So, maybe nobody in the world would be thinking on on those lines, yeah. But we, we are trying to think maybe it would work differently. You see, like... Basically, regulations are the barriers to the innovation. That's why, in rest of the world, we'll think a lot about the sandbox. Being a Pakistan in Pakistan market, we don't have much of the regulation. That's a huge opportunity for us to think differently. You do think differently. Build a test case and show it to the world. Like this is a different way of doing things. These are the outcomes. These are the better outcomes. We would fail in many things. But do you fail fast? That's a wholesome, different experience. I always wish to do that, and I think I'm on the right place to do that.

Ghalib Hafiz

All right, I think we're coming to a close and I will close with one question, which is: some of our future colleagues, some of our future team members are listening and watching us through these cameras. And maybe let's just end with a crisp note around, you know, you guys could be doing... the world is your oyster, right? You could be doing anything. Why are you here? And, you know, potentially why, if they're on the fence or if they're watching from the outside, why should they join us?

Zahid Ali

Uh, so like I would start with myself, like, why I came over here. Like green field experiences go to different. You always work with the people you need to find the right people. All these buildings, brick and mortar. But don't... satisfy a person like me. I want to do things differently. And I feel this is the right place. And this is why I am here. Culture is different, culture is very important. It's not typical like, maybe, a kind of condescending culture. Where you are pushed on every small step, or you have to do somebody, just a big brother, is watching you that's not here. It's a different culture. So this is, I would say, an opportunity. And maybe there would be many crazy people who wanted to do things differently. They have some ideas. And we really want to listen to them. Hear from them.

How they can help us in this journey and how we can help them in their journey. It must not be like a typical like employer relationship. The relationship could be a different relationship. So we are really looking forward to build those kind of relationships. For which I'm here. And I think the... There are tons and tons of opportunities to do things differently. And we have the right kind of team over here. But we need more and more collateral from the fresh mind, people who are coming out of the universities, people who have the experience. Who have urged to do, maybe they have some innovative ideas, but they don't find any ground to do that. So we would provide them the ground to do those innovations and we are partnering with some of the greatest institutions in the world.

So right now I'm not disclosing because it's still a few things in process. But that is a kind of liberty with the people. Uh to understand, uh what's happening in the world, especially with all the collateral that we are building over all together, so that's a phenomenal experience, nobody would think of working in Pakistan. With the people who understand Epic, who understand Cerner, who understand maybe the cloud better than many many other people in this country. So we are those people. And we would give that kind of knowledge and we would let the people bring their ideas, apply with us and... Yeah, do some phenomenal work for the lifetime.

Ghalib Hafiz

You want to add anything to that?

Mustafa Hassan

How do you top that, huh? No, listen, I think this... The opportunity to be part of building Novacare is deeply personal to me. I spent majority of my adult life outside of Pakistan and one of the things that that afforded me is you know the experience to see how great institutions are built? You know, how do systems and people and processes and technology and culture, you know, what are some of the best of those things that come together? build great institutions. And I think what excites me is the opportunity to build a great Pakistani institution. In this country, I don't... think we lack talent. I think what we lack is institutions that are designed and built really thoughtfully. And I think the amount of... and the courage that has gone into building Novacare into what it potentially could be in the future.

I think it's one of the most... incredible of journeys. And I hope that, you know, one day, Inshallah, the hospital will be up and running and delivering care. But I think it's going to... to set an inspiration for many others to take the same kind of leap of faith in this country and build universities. build, you know, hospitality, build lots of different great institutions that ultimately, I think, is going to move the needle in this place. And I think the legacy of that, I think, will outlast my lifetime. And I think that's really what makes this personal and what makes me really excited.

Ghalib Hafiz

No, I think that's, on that inspiring note, this... idea that we're building a national champion for Pakistan and this, on the notion that you know, smart, talented people such as yourselves, the world is your oyster, right?

You can have an opportunity. Come anywhere you'd like, but you know, we come together like-minded people. We like each other and we do this phenomenal sort of work to showcase what we can achieve in this country. I think when we start dreaming about the potential here in terms of what we can do for not only our families and communities, for their health and well-being, what we're doing for providers in terms of creating opportunities at home. You know, that's our dual mission, what we can do for medical tourism, etc. And I think the, you know, for those who are watching and listening. We are about 55 people as we speak. When we open our doors towards the end of the year, we'll be 600 plus.

So there is a lot of opportunity for clinicians, for non-clinicians, anyone who's interested. From healthcare, even from outside of healthcare, who's interested in being part of this journey and this inspiring story in Pakistan. to reach out to us and to join us. We are looking for for folks who share some of our some of our vision and some of our craziness. So thank you so much, uh, Mustafa and Zahid. I think we'll have you back on future topics. Mustafa, we've got you earmarked for a podcast on what it's like actually to return to Pakistan, the Wapistani podcast. Zahid Saab will speak more on this topic and on other topics. But it was wonderful to have you. And thank you to the audience for listening. This is the first in a series of... podcasts that we'll be producing.