“How Technology is Changing Healthcare and the Patient Experience” from Twistle CEO, Kulmeet Singh

How can we improve the patient experience and give physician’s and care teams back much needed time to be better healers? Kulmeet Singh, CEO of Twistle, shares how innovative technologies can automate some aspects of the patient experience helping to increase patient engagement, streamline workflows, and improve outcomes.

Watch on Youtube: The Future of Healthcare – Kulmeet Singh, CEO of Twistle, Tedx ABQ Salon

Read the Full Transcript

I’m gonna talk about what I hope is an ambitious technology initiative in value-based care that Aaron actually is assisting with but I’m gonna start with my baby first. My third. This is moments after she was born. We were overjoyed, absolutely thrilled to have a third daughter but my wife and I were exhausted. And my wife was in a lot of pain at the hospital which was right here at UNM. We got a lot of attention and maybe too much attention with someone checking in on us frequently, being available to us at any hour night or day. But despite all that TLC we wanted to get home. We had two older daughters at home. 

On the day of our discharge, we’d been waiting several hours and the discharge team came and they handed us a stack of documents. Then they decided to follow through on their discharge protocol, which they did so faithfully they went through in minutiae every issue every point in those documents. And about 10 minutes into their lecture I yelled out “shut up and let us go home!” No, I just, I did not do that but I felt something like that. Not much of what they were saying registered for either Jasdeep or for me. And by the way, data shows that in more comfortable situations than ours, patients forget the vast majority of what they’re told. 

So we got home and it was quiet and unnervingly quiet after all that attention at the hospital. There was no one. Not a phone call, not even a text message. And a few hours after we’d been home, late into the night, we did indeed need some help. For some inexplicable reason, it’s inexplicable to us not to probably some of the doctors here, every time Jasdeep would nurse Bahal, our baby, she would start cramping. And the pain was so awful that she would have to stop. For my part, I was like a deer caught in headlights: my wife curled up in pain in one corner, our baby crying in the other and our two older daughters completely confused what’s going on.

In health care, whether it’s pregnancy or it’s surgery or illness, there is a similar pattern of communication, evaluation, and education that is needed to get a patient to a better place. Across medicine it’s the same sequence of engagement. Now the content, the protocol will vary but the pattern is very similar. I’ve spent a career in healthcare technology and artificial intelligence. While AI may aspire and will do some great things, the low-hanging fruit are these kinds of patterns of engagement. And It doesn’t make sense to take expensive doctors and nurses and have them do what an automaton can do as well or better, more consistently. 

The other thing of course that you should know is that our doctors, nurses today are overwhelmed with patient volume and all the administrative chores that go along with it. I was talking to a physician right here earlier and I was saying you like documenting in Cerner or an Epic? it’s a nightmare for them. And so they just don’t have the time to communicate with patients after the patient has left their environment, whether it’s the clinic or the hospital, which is going to be critical for the value-based care that you heard Aaron talk about. 

The evidence shows that communication is the single biggest factor in influencing outcomes such as reducing a readmission. A recent study from Utah explored what value meant to physicians and what it means to patients. For physicians, “improving clinical outcomes” was paramount but for patients “my health improves” ranked slightly below “the staff are friendly and helpful.”l And so the question is can technology give back some time, relieve some burden, give back some cognitive space to care teams to allow them to be more friendly and helpful? And unequivocally the answer is yes. And you can deliver better outcomes. 

So consider this, instead of that abrupt rupture that Jasdeep and I experienced from the hospital, we’d gone home without that tedious lecture, which was in any case not personalized to us. We’d gone home and then a few hours later on our mobile phone we might have a check-in. “How many wet diapers did Bahal have?” And then something about the pediatric visits and something about vaccinations and a check in with Jasdeep. “How are you doing?” To which she would have responded to this conversation, which can be automated, an automaton can have this conversation. “Hey,” she would have said, “I am cramping when nursing.” And then the conversation might have gone something like this: “Well, sorry you’re in this discomfort. It’s not unusual for mothers the second or third time to feel this kind of pain. Essentially, when you nurse you release a hormone, oxytocin. The uterus is a muscle and when oxytocin causes the uterus to contract, and that’s painful, but this pain is actually good for you. It’s your body healing itself. Would you like some meds?” And knowing my wife, who delivered two of our children without an epidural, she would have said no. 

And the automatron can be personalized. They could have responded by saying “Well that’s okay. In some cases, watch this video, you can give yourself a lower abdomen massage and that helps relieve the pain.” This would have been a great experience for us!

Now in our case, I have so many clinicians in my family, we picked up the phone and we found someone to fill that gap in care. But that does not happen for so many mothers. In fact, the data shows that more than 50% of moms in this country stopped nursing well before they should. This has serious public health implications. And so with a whole bunch of smarter people than me, smart doctors, smart artificial-intelligence engineers, we started a company whose mission is to make this vision a reality. Not just for nursing mothers but for any specialty, any diagnosis, any healthcare context, behavioral health or in community health. 

The company’s name is Twistle. And essentially Twistle gets triggered from within the patient record and then, based on the context, we’ll engage with patients in a bi-directional two-way communication with the care team. Basically this is how it works, if the automation engine is not smart enough to handle something that the patient asks it seamlessly hands the conversation off to someone on the care team. As far as the patient is concerned, they’ve been communicating all along with the avatar of their care team or their doctors. Now, they don’t know which messages are coming from the automation and which are coming from someone on the care team. The care team can then intervene. And the system can learn from the care team’s intervention so it alerts the care team less the next time. 

And this can be done not just for joyful experiences, like pregnancies, but also for things like serious surgeries. Keeping a patient on track before surgery or after surgery. Before surgery, it’s more about making sure they prepped themselves and they do all the right things.There’s a lot of evidence right now about patients pre-habilitating themselves so that their outcomes are better. Then after surgery, we can keep them on track by asking them “hey are you spiking a fever? Have you drunk enough water? Is your incision getting redder?” We can do really cool things like connecting with CPAP machines and Fitbit’s to nudge your patient if they haven’t walked enough and applaud them if they walked as much as they should have. So the possibilities are endless. 

Technologies like this have delivered great results. We are sending patients home quicker but, more importantly, keeping them out of the hospital. And of course we’re relieving care teams off of routine conversations. I met an anesthesiologist who said if I have to talk to a patient about the pros and cons of an epidural I’m gonna shoot myself. Right? Why do you need someone at that level to talk about an epidural? We can do that right. And so costs are down and patients love being connected with their care teams.

One of the things that’s going to happen, as populations continue to increase, you’re gonna  hear a term over and over again. Some of the people, some folks in this audience, probably are aware of it: population health management. You’re going to have to engage entire populations. Technologies like this are going to be important for soliciting the patient, for involving the patient in their own care. No longer can healthcare be paternalistic. It’ll have to involve the patient in their own care. 

And so our aspiration at Twistle is to do this, to be part of this story and be a force multiplier for care teams all over the world. In fact, even in parts of the world where there may be no care teams we are playing a role. We hope to be starting an HIV project very soon. Because even in the poorest parts of the world patients increasingly have access, maybe not to an iPhone but to a flip phone. And so we can engage with a mother before and after her pregnancy. And to resolve lactation issues which will have implications public health implications elsewhere and hopefully we will have more healthy girls like mine is today, 15 months later. Thank you.