Podcasts about Scripps Health

Options abound for paid parking systems in Balboa Park meant to help the city's budget shortfall. And San Diego County is also looking for budget solutions, this time toward its reserve. Also, part one of a two-part story looking at the Trump Administration's fixation on birthrates. Then, an East County school is helping kids eat healthy away from school by sending food home with them on the bus. And relief is here for tens of thousands of Anthem-Blue Cross customers unable to access Scripps Health due to a contract dispute.

In this episode, Dr. Darryl D'Lima, Director of Orthopedic Research at Scripps Health, joins the Becker Spine and Orthopedics Podcast to discuss the development of smart shoulder implants, their potential to revolutionize patient care, and the future of orthopedic innovation.

In this episode, Dr. Darryl D'Lima, Director of Orthopedic Research at Scripps Health, joins the Becker Spine and Orthopedics Podcast to discuss the development of smart shoulder implants, their potential to revolutionize patient care, and the future of orthopedic innovation.

In this episode, Dr. Darryl D'Lima, Director of Orthopedic Research at Scripps Health, joins the Becker Spine and Orthopedics Podcast to discuss the development of smart shoulder implants, their potential to revolutionize patient care, and the future of orthopedic innovation.

In this episode, Brett Tande, Corporate Executive Vice President & CFO of Scripps Health, joins Alan Condon to discuss key financial challenges and opportunities in healthcare. From potential Medicaid cuts and their impact on hospitals to the role of AI in revenue cycle management, Brett shares insights on navigating financial sustainability while expanding care access in growing communities.

Veteran members of two San Diego street gangs are working toward peace in their communities. Also, San Diego is rewriting its street design rules, but will it make them safer? Then, TSA workers at the airport protest the end of collective bargaining. Scripps Health makes a big North County investment and in a Public Matters segment Voice of San Diego's Scott Lewis explains why city residents could soon pay more than $50 per month for trash pickup.

After months of failed contract negotiations, Scripps Health has been removed from the Anthem Blue Cross insurance networks of 125,000 San Diegans. Reporter Melissa Mae shares what could happen next. Then, a Catholic school in El Cerrito is fighting to keep its doors open after the diocese of San Diego said it could no longer cover its budget deficit. Plus, reporter Amita Sharma shares how people are navigating dating in a deeply divided time.

A local SDSU student injured in the deadly terrorist attack in New Orleans, we'll break down what we know so far. Fire crews are working to contain a brush fire that started late Wednesday night, near Otay Mountain. You might need to start searching for a different doctor, you're insured by an Anthem Healthcare plan, and go to Scripps Health. NBC 7's Steven Luke has what you need to know to start your Thursday.

The 340B drug pricing program is crucial for safety-net hospitals and other providers that care for patients in need, especially those whom traditionally have been underserved by the broader health system. We speak with Dr. Tony Jackson, assistant vice president for pharmacy services at Scripps Health in San Diego, for his views on why 340B is “all about health equity.”340B Helps Serve the UnderservedJackson stresses the variety of services and support that 340B funding enables at Scripps Health. Because of 340B, Scripps can serve large populations of patients in the area who are homeless, lack health coverage, and are dealing with higher rates of chronic illness and disease. It does so in part through partnerships with community health centers and other community groups on outreach to those populations. Restrictions to 340B Threaten Patient Care340B savings help support vital Scripps services that include emergency department care, access to specialists, discharge and maintenance medications, and community health benefits such as disease screenings. Jackson notes that drug company restrictions on access to those savings threaten such services and risk creating health care deserts in the area.Representation and Advocacy MatterJackson is part of the Association of Black Health-System Pharmacists (ABHP), which works to increase Black representation in the pharmacy field with the goal of improving underserved patients' trust in pharmacists and access to needed care. He notes how ABHP leaders have advocated for 340B with the understanding of how important it is to the pursuit of health care equity.Resources340B Health Equity Report 2023Black Pharmacists Stand as Advocates in Support of 340B Access to CareSenate Letter to HHS on Rebates

In this episode of the Two Minute Drill, Drex delves into the recent cyber attacks on Change Healthcare, revealing the tactics of ransomware gangs like Alpha VAKA Black Cat and Ransom Hub. With a ransom of $22 million in Bitcoin and stolen sensitive data at stake, the episode explores the harsh realities of cyber extortion in the healthcare sector. Drex also highlights the outdated National Vulnerability Database and its implications for cybersecurity. Featuring insights from Scripps Health's CEO, Chris Van Gorder, and useful resources for staying updated on cybersecurity trends, this episode is a must-listen for anyone concerned with healthcare security.Contributions & Community:Become part of the conversation and help shape future episodes by contributing stories and insights. Visit thisweekhealth.com/news and click on "Become a Contributor."Stay Connected:Don't miss out on our upcoming episodes focused on hacking healthcare. Follow our podcast, like and share this post to spread the word, and join the new 229 cyber and risk community for more in-depth discussions and resources.Stay Informed, Stay Secure:Visit thisweekhealth.com/security for more information and resources to bolster your cybersecurity knowledge and defenses.Remember, Stay a little paranoid.

Tracy Chu, Corporate Vice President, Population Health/Chief Executive, ACO, Scripps Health joins the podcast to share her strategic vision for the next year, exploring the landscape of population health. She discusses the initiatives in her domain, transformative projects shaping the future of healthcare, and the essential steps healthcare executives must take now to ensure the success of their organizations.

Tracy Chu, Corporate Vice President, Population Health/Chief Executive, ACO, Scripps Health joins the podcast to share her strategic vision for the next year, exploring the landscape of population health. She discusses the initiatives in her domain, transformative projects shaping the future of healthcare, and the essential steps healthcare executives must take now to ensure the success of their organizations.

Jon discusses the increasing trend of hospitals dropping Medicare Advantage plans, emphasizing the importance of understanding how healthcare providers get paid. Jon from Contract Diagnostics, highlights the potential impact on clinics and providers, as Medicare Advantage covers a significant portion of seniors.  The article quotes Scripps Health, stating that hospitals are adopting a strategy of "delay, deny, and not pay" for Medicare Advantage. Jon urges healthcare providers to be aware of the potential consequences on patient volumes, income, and compensation schedules, emphasizing the uncertainty of the situation.  Contract Diagnostics, a consulting service, offers assistance in navigating such challenges and promises ongoing support for healthcare professionals. Jon also mentions the relevance of this issue in an election year and encourages staying informed about future developments. Jon invites individuals to contact Contract Diagnostics through phone, chat, or email for personalized assistance, visit www.ContractDiagnostics.com

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It's often said that to be a good CDI or coding professional you have to roll up your sleeves and get clinical. If you code just what is explicitly documented you will miss opportunities; if you don't understand A&P and pathophysiology, you will make mistakes. But what about those who take the opposite path? Katie McLaughlin became a registered nurse at age 23, then went back to school to earn her doctorates before becoming a nurse practitioner in 2007. Today—at least until very recently, when her organization opted to discontinue accepting Medicare Advantage patients and shuttered its risk adjustment program—she became Population Health Clinical Advisor: Clinical Documentation Integrity, Risk Adjustment, and Epic Informatics, for Scripps Health. A clinical path, to coding and CDI. Today she is looking for the next opportunity. But given her clinical foundation, coding expertise, EHR savvy, and above all, passion and vision, she will be landing very well, and very shortly. Katie joined me for this week's episode of Off the Record, where we discuss: • Her path into nursing, clinical medicine, and ultimately risk adjustment • Prospective chart reviews—a 2 a.m. vision, and implementation • Leveraging Medicare annual wellness visits • Scaling risk capture by customizing EPIC • Building dedicated Internal Wellness Clinics focused on screening and risk capture • Unexpected free time and plans for her next career move

Open enrollment for Medicare just started, and more than 30,000 Scripps clients in San Diego County who have Medicare Advantage plans are facing a difficult choice. In other news, it's Undocumented Student Action Week on community college campuses across California. Plus, we hear from the San Diegan who was named the “Most Influential Filipina in the World.”

Scripps Health Chief Medical Officer Anil Keswani, MD, shares his perspectives on population health and the approach to population health at Scripps.

June 27: Today on TownHall Reid Stephan, VP and CIO at St. Lukes speaks with Shane Thielman, Corporate SVP & Chief Information Officer at Scripps Health. How did Scripps Health measure and analyze the effectiveness of telemedicine in terms of patient experience, adoption rates, and provider productivity? In what ways did the implementation of telemedicine block scheduling benefit Scripps Health, its providers, and patients, and how did it address the challenge of access to timely care? In terms of ambient listening experience, what is the demonstrated desire among clinicians to use this capability, and what factors need to be considered to determine the financial viability of implementing it?"The Patient Experience - A Technology Perspective" is a live webinar that explores the intersection of healthcare and technology, focusing on enhancing the patient experience. As healthcare systems prioritize patient-centered care, leveraging technology becomes crucial. Join us on July 6th, 1:00 PM ET and join the discussion! Register Here. - https://thisweekhealth.com/leader-series-the-patient-experience-a-technology-perspective/Subscribe: This Week HealthTwitter: This Week HealthLinkedIn: Week HealthDonate: Alex's Lemonade Stand: Foundation for Childhood Cancer

June 16, 2023: Shane Thielman shares his journey and experiences as the CIO of Scripps Health as well as all the initiatives Scripps is taking in this upcoming fiscal year.. What is the process of determining technology priorities and investments at Scripps Health for the upcoming fiscal year? How has the organization's approach to technology investments changed in recent years, and what is the focus for fiscal year 24? How does Scripps Health measure and demonstrate the value of its technology projects? What strategies does Scripps Health employ in managing change and driving adoption of new technology solutions? How does Scripps Health envision the future integration of technology into its care delivery model?Key Points:Scripps Health overviewTechnology background and deficiencyFiscal year planning and prioritiesMeasuring and demonstrating project value"The Patient Experience - A Technology Perspective" is a live webinar that explores the intersection of healthcare and technology, focusing on enhancing the patient experience. As healthcare systems prioritize patient-centered care, leveraging technology becomes crucial. Join us on July 6th, 1:00 PM ET and join the discussion! Register HereSubscribe: This Week HealthTwitter: This Week HealthLinkedIn: Week HealthDonate: Alex's Lemonade Stand: Foundation for Childhood Cancer

June 14: Today on the Conference channel, it's an Interview in Action live from HIMSS 2023 with Tracy Chu, Chief Executive, ACO/Corporate VP, Population Health at Scripps Health, and Cynthia Church, Chief Strategy Officer at Xealth. How did Xealth help address the problem of low patient engagement and underutilization of health services and programs? How can healthcare systems effectively engage patients in the digital era and adapt to increased consumer choices? What are the key success measures and outcome measures used to evaluate the effectiveness of the Xealth implementation in improving patient care and engagement?Join us on July 6 at 1PM ET for our webinar: The Patient Experience - A Technology Perspective - Integrating technology and patient care is more pertinent than ever in the ever-evolving healthcare landscape. With a rising focus on patient-centered care, health systems now leverage technology to enhance patient experience. This transformative shift calls for leaders to adopt a comprehensive perspective that can bridge the gap between technology and patient care. Register Here: https://thisweekhealth.com/patient-experience-technology-perspective/Subscribe: This Week HealthTwitter: This Week HealthLinkedIn: Week HealthDonate: Alex's Lemonade Stand: Foundation for Childhood Cancer

In this episode, regular guest Molly Gamble, Vice President of Editorial at Becker's Healthcare, joins the podcast to discuss key takeaways from a conversation she had with Chris Van Gorder, the CEO of Scripps Health about what makes a health system a great workplace, and new types of mergers & acquisitions that emerged from the pandemic.

Today's guest is Patrick Chen, Senior Director of Business Intelligence, Growth and Accountable Care Enterprise at Scripps Health in San Diego, CA. Each day at Scripps, they put the vision of their founders — Ellen Browning Scripps and Mother Mary Michael Cummings — into action by dedicating themselves to quality, safe, cost-efficient and socially responsible health care for everyone that they serve. Scripps keeps that vision at the forefront as they care for patients, engage in clinical research and ultimately improve community health. Patrick is a senior leader for business intelligence and growth at Scripps Health, specializing in the development of innovative partnerships and leveraging advanced analytics for market intelligence, healthcare economics, and mergers & acquisitions. He is deeply committed to driving positive impact in underserved communities for both clinical outcomes and social determinants, with thoughtful execution of data-driven population health programs and technology enabled solutions. In the episode, Patrick will discuss: The mission they work towards at Scripps, Their work within population health & business intelligence, Challenges the Data Science team are solving in Healthcare, What the next 12-24 months has in store and Career opportunities with Scripps

Scripps Health announced last month that physicians at Scripps Mercy Hospital named a new chief of staff. The announcement of Dr. James Grisolia's selection praises the neurologist's accomplishments and notes that he is a nearly 40-year veteran of Mercy's medical staff. Union-Tribune health care reporter Paul Sisson, communities editor Tarcy Connors, managing editor Lora Cicalo, and publisher and editor Jeff Light discuss why some are calling the announcement very controversial.

In today’s shoutout of the day Scott Becker spotlights Chris Van Gorder, President & CEO at Scripps Health.

In today’s shoutout of the day Scott Becker spotlights Chris Van Gorder, President & CEO at Scripps Health.

In today’s shoutout of the day Scott Becker spotlights Chris Van Gorder, President & CEO at Scripps Health.

In today’s shoutout of the day Scott Becker spotlights Chris Van Gorder, President & CEO at Scripps Health.

In today’s shoutout of the day Scott Becker spotlights Chris Van Gorder, President & CEO at Scripps Health.

In today’s shoutout of the day Scott Becker spotlights Chris Van Gorder, President & CEO at Scripps Health.

In today’s shoutout of the day Scott Becker spotlights Chris Van Gorder, President & CEO at Scripps Health.

In today’s shoutout of the day Scott Becker spotlights Chris Van Gorder, President & CEO at Scripps Health.

In today’s shoutout of the day Scott Becker spotlights Chris Van Gorder, President & CEO at Scripps Health.

In today’s shoutout of the day Scott Becker spotlights Chris Van Gorder, President & CEO at Scripps Health.

Maria is a palliative care and board-certified emergency physician who cares for patients at San Diego area Scripps Health campuses, primarily focusing on Scripps Mercy Chula Vista. She is an immigrant and first-generation college graduate who achieved her calling as a physician on a nontraditional pathway. An experienced former educator, with a focus on middle- and high-school mathematics, Maria majored in elementary education, then earned master's and doctoral degrees in mathematics education and educational leadership, respectively, while teaching full-time. Her doctoral dissertation addressed the gender gap in STEM fields and rekindled her desire to become a physician; she went on to attend Vanderbilt School of Medicine and trained in Emergency Medicine at Kaiser Permanente San Diego, followed by fellowship in Hospice and Palliative Medicine at UCSD.

July 5: Today on TownHall https://www.linkedin.com/in/samueljhill/ (Samuel Hill), Director of Product Marketing at https://www.medigate.io/ (Medigate) speaks with https://www.linkedin.com/in/rubino-steven-02407117/ (Steven Rubino), former Biomedical Engineer and Project Manager at https://www.scripps.org/ (Scripps Health) about the importance of collaboration between Biomedical Engineers and IT Departments to improve care. Then, Samuel and Steven run through the top 7 myths and misconceptions about medical devices and cybersecurity. What has changed over the course of Steven's career as a Biomedical Engineer? Why does he believe Biomedical Engineers should be at the table for discussions on cybersecurity?

According to Scripps Health, daily COVID volumes at their five hospital campuses peaked two weeks ago. Scripps predicts the omicron surge is winding down. Meanwhile, the San Diego History Center's exhibit, ‘Celebrate San Diego: Black History & Heritage' showcases the rich history of Black San Diego. It's timed for Black History Month which began on Tuesday. Plus, a City Heights rehab center provides a safe pathway to recovery for LBGTQ individuals that struggle with alcohol and substance abuse.

Lisa is having success with her memory course and is being asked “How come this ins't on line?”  Where can I get more information?  And moreover her mom is stressed out about her memory.Lisa Randall is a memory memory Specialist.  She has her education in Kinesiology, (MS) Gerontology and Public Health, and hung with the memory pro's at Scripps La Jolla.  And her “Memory Alive Program has delivered engaging and effective transformational memory training to individuals and small groups, along with corporate and community organizations for many years.See everything Lisa Randall here: https://integrativememory.comSee her current offerings here: https://integrativememory.com/current-offeringsSee her memory meditations on YouTube here: https://www.youtube.com/channel/UC0A3cQ1xlafZpj-nf5RyJcQEmail her here: lisa@chunkyseahorse.comSome of the takeaways:Spirituality tied with memory and your mental health.  The physics behind it.  Both memory and spirituality.  The parallels.The power of emotions and sensations on our memory.  The power of emotions on our ability to remember.What do you say to someone who is 65 or 70 who is balking at this program? I would tell them that, that all of neuroscience contradicts their belief that memory loss is inevitable, and, and that the concept that as I age, I will then lose my memory and forget is one that we buy into. It is not based on science, the brain is plastic, the brain never stops. It never loses its ability to generate new neural connections.We never are too old to stop changing our brain ever. And so I would point people to science, there's way too much science. We simply have bought into a concept that's that scientifically unfounded.Her success stories ...the reflection on how much more they're enjoying the moments that they are creating.  How much more they are focused on creating memories that they want to keep. And that's been the moments that give me the chills.  Where I think that is it.   Because who cares if we can remember a bunch of shitty moments strung together right? But if we are focused on being present, and being aware and really valuing the creation of beautiful memories, that's it. What could be better than that? That is what I have loved.Administrative: (See episode transcript below)WATCH the Table Rush Talk Show interviews here: www.TableRushTalkShow.comCheck out the Tools For A Good Life Summit here: Virtually and FOR FREE https://bit.ly/ToolsForAGoodLifeSummitStart podcasting!  These are the best mobile mic's for IOS and Android phones.  You can literally take them anywhere on the fly.Get the Shure MV88 mobile mic for IOS,  https://amzn.to/3z2NrIJGet the Shure MV88+ for  mobile mic for Android  https://amzn.to/3ly8SNjSee more resources at https://belove.media/resourcesEmail me: contact@belove.mediaFor social Media:      https://www.instagram.com/mrmischaz/https://www.facebook.com/MischaZvegintzovSubscribe and share to help spread the love for a better world!As an Amazon Associate I earn from qualifying purchases.Transcript:Mischa Zvegintzov (Intro) Welcome, everybody to the Table Rush masterclass where we get back to the marketing and sales basics to help entrepreneurs like you grow your business to $1 million annual revenue and beyond.Mischa Zvegintzov And today, I have a very special guests, Miss Lisa Randall, and Ms. What a great introduction. I've totally gone sideways. Right from the start. I was looking at your website, and it says, meet Lisa Randall. Ms. So I was like, Miss Lisa, whatever. And Lisa and I have a little bit of a history where we're great friends, correct, Lisa?Lisa Randall Correct. That is awesome.Mischa Zvegintzov And, Lisa, you're a memory specialist? Yes. That is correct. Fantastic. And you have a program called Memory Alive. The Memory Alive Learning Program, which we're going to discuss a little bit. Yes. Yes. Fantastic. And you have an education in Kinesiology.Lisa Randall If I remember correctly, yes. That isMischa Zvegintzov Perhaps some gerontology and public health? Yes. Yes. in gerontology means older than us people.Lisa Randall Oh, Study of Aging.Mischa Zvegintzov Study of aging?Lisa Randall YeahMischa Zvegintzov And let's see what else you have delivered engaging and effective transformational memory programs to individuals and small groups, along with corporate and community organizations for many years. And with the fantastic style and flair that is Lisa Randall.Lisa Randall Absolutely.Mischa Zvegintzov Fantastic. So our story is, you've been a part of my entrepreneurial journey, which is super fun. I'm having Microphone. Microphone insecurity. There we go. Yes. So I started the Bitch Slap accelerated path to peace podcast. And you were actually my very first interview. And we were having so much fun. And we went so deep and talked about so much like deep personal stuff that we kind of came to the conclusion that maybe now's not the time to publish that episode. Correct.Lisa Randall That's how I recall it. Yes. Mischa Zvegintzov We were talking about wound'y things that were like perhaps some people just don't need to know about this yet, but I'm sure if we talked about it today would all be fine. But it was part of my growth experience too, because I was so attached to having that interview go out there that I fought you very hard. It as a matter of fact, I fought you hard enough that I went ahead and and somehow manipulated the universe into having it be okay that I just went ahead and publish the episode. And, anyway, I great I finally took it down. I was like, Man, I'm just Misha, you're just like being an asshole. Excuse my language listeners, but it does happen. Sometimes we can be willful and push envelopes. But it was such a you were such a great part of my, my journey as I'm growing entrepreneurially so thank you, Lisa.Lisa Randall You're welcome Mischa.Mischa Zvegintzov What's that?Lisa Randall Thank you.Mischa Zvegintzov Yes. And so we thought it would be fun as I'm transitioning out of this more spiritual ethereal style. I don't know if message is the right thing but my own journey.  I was like, oh, maybe I'll help people find God or whatever. I was like, You know what, I really love business and really talking business and growing businesses and and spirituality being expressed through entrepreneurial endeavors. I think that's a much better way to path for me, right? And so you and I were like touch wouldn't be awesome to to sort of have an end Bitch Slap last interview. Wouldn't it be ironic if the first interview that went nowhere? If you got to be the last? The last Bitch Slap accelerated path to piece of the official interview.  Sort of close that loop. And then at the same time, Hey, you are this amazing... You are this amazing entrepreneurial spirit that you're embracing now, like you're ready to level up your business, right? Like what we just talked about that you do.  And that perhaps you put aside some of your, you know, gladly put aside some of your entrepreneurial aspirations or you know, PhD aspirations, things like that so you could grow a family and have some babies and things, and things like that. Yeah?Mischa Zvegintzov Good. Thank you for that dissertation. Everybody who's listening, I've just totally co-opted this episode, and made it about me. But what the hell, I have a gift? So Lisa Randall, after that amazing, wonderful, beautiful, beautiful introduction, why don't you talk to you've, you've got this Memory Alive. thing, but that, hey, it's time to? When did you tell tell us about where you are with it a little bit. I know you teach classes, your community centers or frame what you're doing right now and perhaps, given give us a vision of what you hope for?Lisa Randall Yeah.Lisa Randall I absolutely will. Thanks Mischa. I love how you said, you know, expressing spirituality through entrepreneurial endeavors. I thought that was a really cool way to say... it kind of it really articulates Well, I think the transition that you're making, and also what this process of starting this company, and teaching what I've been teaching has been for me.  So that was really, really beautifully articulated and I appreciate that. And so, the the process of putting together this memory program started for me when I was working full time for Scripps Health, and I was working in integrative medicine. And so, it was born of a very, you know, scientifically based practice pragmatically based foundation.  Of, you know, what...Lisa Randall What is a whole person approach to better memory, what is the whole person approach to preventing memory loss, and based on the foundation of, you know, all kinds of other programs that I helped to create it scripts. And when I took it on my own, when I left scripts, and I began working on this program on my own, it was, it was also at a time when my life was transforming, you know, I was going through divorce, and I was recreating, really kind of transforming as a as a person. And so this, this, the topic, the content has shifted in its meaning for me, and it's also translated into a new way that I approach teaching classes. And, interestingly, as the, as the meaning has, as changed for me and has I...Lisa Randall As I have really gotten so much more spiritually focused, I found that the content that I'm teaching is so much more well received, so much more effective. And I have really found a way to connect with the my students and, and the content on such a deeper level. And that's been a really beautiful thing for me. So, you know, as I've, as I've gone through this, you know, over the last several years through this transformation in my personal life, and as I've transformed the content that I've been teaching.  I have, you know, I'm at a place right now, where there is there's a ton of passion behind what I'm doing. And as I continue to see the, the, the, what I'm producing, benefit the lives of the people that I teach my motivation to do more increases. And so I have people asking me, why isn't this online? Where can I get more information? I have a... My mom is stressed out about her memory, how can I help her and there's so many things that I want to do a provide, but I feel inept, I feel at a loss for how to take the content that I've created, and the passion that I have for it along with the new confidence that it's really benefiting others. And how do I take that and move that to a space where I can make it more accessible for others?  And also make it a more I also build a more secure business out of it as well.  So that I can spend more time on it and so that I can make this a more substantial means of supporting myself and my family.Mischa Zvegintzov Mm hmm. Fantastic. I love that I think Can we touch on two points real quick?Lisa Randall Certainly.Mischa Zvegintzov So you said you, you had a shift in here somewhere, partially due to divorce or a realignment of your identity? Maybe there's a bunch of different ways to say that. But your... the way you were teaching, you started to bring in that spirituality spirituality. Was that a conscious decision? Or was that an epiphany moment? Or tell me about that that arc? Does that question make sense?Lisa Randall It does. It does. I think it was a combination of the two. I think that, you know, I've always been kind of looking for that purpose, right? I've always been looking for what you know, what am I always been so jealous of friends who have said, I want to be a doctor, I want to be a fill in the blank, because I have always been like, I don't want to be Ah ___________. You know, but I know how I want to feel. I know, I want to feel like I'm productive. And I know that there are there are qualities that are intrinsic to me that are useful to others. And I want to use that I want to have the feeling of knowing that those intrinsic things are benefiting others. And I think that's very common. I think that's what some people are really clear on what those qualities are and how to use it. I've never been clear on either. And so the shift was conscious. And it was also based on epiphanies. And I think that consciously it's been the knowing of "I want to pursue that passion". But shoot was that passion in the first place, right. And I knew I was passionate about this subject. And it wasn't one that I was going to drop researching regardless of whether or not it was my, my job because...Lisa Randall I'm fascinated by neurology, I'm fascinated by memory, I'm fascinated by the brain. And I'm always going to be looking into that, I think, as my, my spiritual education, for lack of a better term, as I dove more into spirituality, I think what what struck me was the science behind the spirituality that I pursued.Lisa Randall So when I read on quantum physics, when I read about, you know, when I looked at David Hawkins and letting go.  And the science behind spirituality, it all lined up with the, the, the fundamental components of memory and cognition, that I was teaching in a really insightful way. And so there were several moments where I, where I had, you know...Lisa Randall I did a reading I had a recognition that, you know, in order to remember better, we must be paying attention, we have to like the crux of a good memory, is attention, the crux of a good memory is the ability to be present. And, and I recognize that I can't be present unless I can forget a lot of my old ideas, a lot of my story, a lot of my story that prevents me from being being emotionally mentally, spiritually present to the to the here and the now. And I had that cool epiphany...Mischa Zvegintzov I was that tell me about that epiphany. Was this like your daughter? Or an ex husband? Or some, some? Some? Do you remember the day or the moment? Or...Lisa Randall I remember, specifically, I mean, I remember generally speaking, the, the the idea of like, oh, my gosh, I have to forget before I can remember. And I would love to share with you something that I read the very next day after I read this. And it was, it was in second sorry, we fight but yeah, it was about it. It was about two years ago.Lisa Randall And I I think that the bizarre contradiction of forgetting in order to remember struck me but I knew it was the truth. And on the very next day, I read in one of my spiritual books... no one questions that connection of learning and memory, learning is impossible without memories, since it must be consistent to be remembered. I said before that he teaches remembering and forgetting, but the forgetting is only to make the remembering consistent, you forget in order to remember better. Lisa Randall And that's directly from a spiritual text. Nothing to do with cognition with memory, but it did fall into my awareness the day after I had this epiphany about "I gotta forget, I gotta forget my, my old ideas, my my story", and and that concept forgetting is essential to the ability to remember not just for me, but but on the whole, and not just in a spiritual sense, but in a cognitive sense.Lisa Randall And so, with those, with these, you know, these things fall into your awareness at certain times, and you can't ignore the timing of those, you know, I can't ignore the fact that I read that the very day after I had this, this epiphany!  And those are the types of, I would say, affirmations that I've gotten over the course of the last few years, that have helped me to know that I am doing what I'm supposed to be doing. And, and B, this is meaningful work outside of just...Lisa Randall I want to be smarter, I want to be more cognitively fit. Those are, those are really, those are really fabulous goals to achieve, too. But there's something bigger and greater that through that desire through that goal that so many people have, "I don't want to lose my memory", I don't want to, you know, "I don't want to go through dementia, memory loss, etc". Through that desire to prevent losing our memory, there's a greater, there's a greater message. And whether that message is just for me, or for the people that I could bring it to, that gives it so much more purpose for me.Mischa Zvegintzov I love that. That's amazing. Can I ask you a question? And, and I'm gonna ask you to perhaps be vulnerable? Are you open to that?Lisa Randall Sure of course, fantastic.Mischa Zvegintzov So you have this epiphany in the moment you read in your spiritual, in the spiritual texts that has meaning to you brings you connection to Source... your... there's obviously a struggle going on, on one side of you, and you're trying to break free of a situation, clearly, right. And so then you're like, you have this epiphany, I need to I need to, how do you say forget to remember, I'm sorry? Forget to...Lisa Randall Essentially I need to forget? Yeah.Mischa Zvegintzov Right. So you're like... I need and so is this?Mischa Zvegintzov What is that tension that's driving that? Is it with relationship? is it with, with something, there's a tension point that you're trying to break free from?  Can you talk to that? because that's obviously, I think, an important piece of your story right here. It's like, hey, reality is, I can be free of this. I've just, i Everything's coalescing by my gerontology and public health. So I get to, you know, I'm trying to help seniors or people age, memory gracefully, and retain and grow and strengthen their memories and these sorts of things. And, and... and you're a spiritual person, right, which I love about you. And so like, it's you have that lightning bolt moment, do you read? But what's the tension point? That's, does that make sense?Lisa Randall Kind of, um, like, kind of what am I trying to be free from?Mischa Zvegintzov Thank you.Lisa Randall Yes. Okay. So, um, and I don't know how specifically I can answer that question. But I'm, you know, I think that...Lisa Randall I think we can all recognize in ourselves certain ways that we think act and operate that don't serve us. That don't serve our freedom. Right. Yeah. And I certainly have had the ability to look back on my life and recognize, "wow", you know, I've certainly made things harder than I have needed to. and all for the sake of protecting how I wanted to be perceived. Or how I wanted people to think about me. Or how I didn't want to think about myself, perhaps. And, you know, I think that there, of course, are always specific situations that I can point to, I was kind of redefining myself after divorce. I was trying to, I'm trying to validate myself in a way that, you know, externally, I felt I needed to..., well, you know, also recognizing that external validation wasn't even available.Lisa Randall And also, you know, looking back on an entire lifetime of, of thought processes that that were that were those that kneecaps me.  You know, that I kneecapped myself and, and I kneecapped my own progress, spiritually and financially and, you know, in terms of my education, and I'm just looking at my My freedom was contingent upon letting go of, of these old ideas.Lisa Randall And, and when it comes to, you know, I think when we, when we get an integrity with ourselves when we get an integrity with what our foundational values are, and, you know, with, with how we're thinking, the words we're using to communicate and then how we're acting, well, what are we doing in this life it isn't in integrity with, with our... with what we really believe and what we think. And there was discord there, and I couldn't be present to, to the, to the moment I couldn't be present to my kids to my career to anything, if I was living in this turbulence, that that existed in the discord between how I thought things should be or my ideas about the way things should go based on crap.Lisa Randall You know, like, (Yeah thank you) there and I think that that was the epiphany of like, wow, I need to forget, I need to forget about my anger towards so and so I need to forget about how I don't think I'm good enough, I need to forget about how my life should look, you know, like, why I why it's a, you know, a failed marriage or a failed career or failed, I need to redefine all those things. Lisa Randall I need to open up my mind to a new definition, a new concept of what of what success is because, because getting into alignment with myself, that's the only measure of success that I want to strive for. And I know that when I am in alignment with my true values, alignment, integrity, and when I am able to live a spiritual life that that holds hands with my career that holds hands with my relationship that holds hands with how I raise my kids, that's when the only time that is the only time and place that the that what I create in terms of my career and what I offer the community. That's the only place that that could grow.Mischa Zvegintzov Perfect. You know, you answered the question beautifully. Thank you for that, um,Lisa Randall Maybe excessively?Mischa Zvegintzov That's all right. You know, we're gonna refine that. Lisa Randall. That's one of the things we're gonna work on. (Fabulous) Yes, so tell me so we've got your, your Memory Alive that's come out of this, come out of this cauldron of change and growth and spirituality and color and you're like, oh, my gosh, I I literally have a vision. Right?Mischa Zvegintzov And so tell me about the Memory Alive program. What are we doing here? What's it doing? Like you're helping what seniors? What do you what's going on?Lisa Randall Well, target audience. Misha is unfortunately you and (Laughter) I are actually the, the, the the demographic that can do the most in terms of improving cognition, preventing, preventing memory loss, but but everyone at any age can take steps towards a better memory. And that's one of the taglines that I use any everyone at any age, the brain is ah, as we all know, the brain is elastic and so we can always make steps to improve the way we think. And, and, and learn and grow. So basically, yes... what I do is I teach...Lisa Randall I talked about emotions and the the power that emotions have on our ability to remember and also the power that we have to look to and foster specific emotions, we do have choices over the emotions that we sit in, and also the fire so attention change, emotion and sensation, the sensations that we experience. Our episodic memory, involves all of our emotions, all five arguably states of our of our senses. And so these foundational components, make up the Memory Alive program and I teach them through a series of classes and resources.Lisa Randall the fundamentals of this program which our attention the the improving our ability to be able to pay attention to be aware, promoting, inviting change into our lives, inviting the ability to have new experiences, that do promote neuroplasticity, and cognitive reserve, but also joy and, and experiences that we care to remember.Mischa Zvegintzov Fantastic. And do you have a set? Currently, do you have a set number of classes? Is it yes,Lisa Randall it varies depending on who I'm teaching. So there's not currently a set number of classes. And that's one of the things that I'm working to kind of streamline and and hone in on.Mischa Zvegintzov Oh, fantastic, good, good, good, good. And in a nutshell, I know, I know, everybody can perhaps thrive by learning how to, you know, maximize their memory. But like, again, maybe talk to this target market.Mischa Zvegintzov So you've got people our age in their 40s, and 50s. And where you're trying to, excuse me, you're trying to sort of help them at a time when perhaps memory can start to taper off. You're like, hey, let's, let's actually help you thrive with your memory and perhaps stave off memory degradation into the, into our senior years.  Am I framing that properly is that kind of...?Lisa Randall And I would I, you know, I think I kind of jokingly said, you know, you, you and I are the target audience, and we might from my business, my target audience is, you know, 60s to 90s, probably.  And it is the it is the older adult who's, who is looking to strengthen their memory. And there it could be because there's fears about things that they forgotten in the past.  It could be there's fear around watching a family member or a loved one go through memory loss.  And it couldn't be just out of the knowing, hey, I want to stay cognitively robust. What was the second part of your question? Show? Sorry, I forgot.Mischa Zvegintzov No, no.  No, I think you answered it perfectly. You said, hey, the you're helping? Well, it sounded like two things, you're helping people that are in their 60s to 90s Stay cognitively robust. And perhaps at the same time, you're helping people who are with somebody who's not cognitively robust, and maybe wants to know, more tools and things like that. So they can thrive in that environment. Yeah?Lisa Randall It's all focused on the individual. So I don't really I don't really, if I'm working with someone who's also a caregiver, my, my program is, is, is for the participant. So you know, there's a completely different set of needs for people who do have dementia or Alzheimer's disease, but a lot of things that I teach are contraindicated for someone who actually is experiencing more advanced stages of memory loss.Lisa Randall So it is it is very much on preventative end of things.Lisa Randall However, in my humble opinion, I do think that what I am teaching would definitely benefit the mindset of someone who's also working as a caregiver for someone with memory loss.Mischa Zvegintzov Great. I love that. But currently with with your program, right now, it's more for the person that's wants to wants to work on their cognitive, how did you say that?Lisa Randall They want to become more cognitively robust. We're learning. We're learning better ways to remember. Right? So it's, if you look at it as part of continuing education or adult education, people that want to learn how to remember better,Mischa Zvegintzov And have you do you have any? Do you have, you're having if this online, you need to grow this, you need to, you need to expand and get this message out to more people because what you're doing works.Lisa Randall Yes, right. I would love to be right, exactly. I have people asking me for things. And I have, I am so excited to get more clarity on how to give it to them.Mischa Zvegintzov Fantastic. Can I ask you another question? Absolutely. I'm sure people that are looking people that are looking at your course that are in their, you know, 60s to 90s. And they're aware that they've got some that that they're at the point of they're ready. They're like, hey, you know what, I am ready to work on my memory because I clearly see it's going to help me have a richer life into my twilight years. However we want to however you want to say what's that? Yeah.Lisa Randall Into my 110s or whatever we'reMischa Zvegintzov gonna call Yeah,Lisa Randall so we'll getMischa Zvegintzov there. Like, what's the thing inside of that person? That's like maybe I've lost too much memory to do this program? Or what what's that thing that internal thing that keeps that you see keeping people from diving into something that can clearly help them?Lisa Randall Yeah, I think that yeah, you I think you hit the nail on the head. It's too late for me. That ship has sailed. I'm already losing my memory. What's the point? Old people lose their memory. It's a foregone conclusion. The there, the self fulfilling prophecy is definitely something that cuts people off from wanting to do the program, or? Yeah, I guess, I guess that would be that would be my answer to that.Mischa Zvegintzov And what would you say to that person like, like, you've got this person who's in let's say, they're 65 or 70. And they've, they're there. They're like, it's too late. Why, why, why? Why start now?Lisa Randall I would tell them that, that all of neuroscience contradicts their belief that memory loss is inevitable, and, and that the concept that as I age, I will then lose my memory and forget is one that we buy into. It is not based on science, the brain is plastic, the brain never stops. It never loses its ability to generate new neural connections.Lisa Randall We... if ah... let me give you an example. So in our 30s, if we walk into a room and we forget why we walked into a room, we probably laugh and think, Oh, I forgot why I walked into the room, and we carry on with our day. If we're in our 70s. And we walk into a room and we forget why we walked into a room, we think oh my god, I'm getting Alzheimer's disease. And our cortisol level goes through the roof. And now we're stressed out, which is the kryptonite format, right literally erodes the hippocampus in the brain. And we have now planted the seed in our mind so that the next time that we have a mental lapse that we may have experienced in our 20s 30s 40s, we have now assigned an entirely new meaning to it.  We've given it the power to tell us that yes, it's another sign that my memory is going.Lisa Randall I heard something so good the other day, and it said, hey, you know, when you can't find your keys, you shouldn't worry about dementia, when you forget what your keys are for, then it's time to start. And I thought that was so perfect, because (oh my god), we will we will, we will just have whatever no big deal when we're young, because it's no big deal.Lisa Randall But when we're older, it stops being no big deal because we're afraid. And with that fear, we put ourselves we put ourselves on a track of, of narrowing the way we think of eliminating new experiences of allowing our brain to fall into these well worn pathways that limit its physiological ability to continue to, to grow and expand and learn.Lisa Randall We never are too old to stop changing our brain ever. And so I would point people to science, there's way too much science. We simply have bought into a concept that's that scientifically unfounded.Mischa Zvegintzov So can I can I speak to that really quick? So if what I'm hearing you say like the Memory Alive program... will help you... It's going to help you with your memory, but also reduce cortisol levels, all this sort of stuff, perhaps I don't want to speak too much to it. But I'm just I'm just thinking like, okay, the idea that that it's too late, or... that's all BS, right? I'd love that. Thank you for answering that. And I'm also going to say you probably being you have your master's and all this stuff, like you've got the paperwork to prove it. You've done this study, you've worked in the business, you've created classes, you've been doing this for how long in your life?Lisa Randall 15 years, probably I said working it generally speaking in that field.Mischa Zvegintzov Okay. And so you probably have studies that verify what you're talking about, like if I said, Hey, well prove it. You could say, Okay, give me 20 minutes, I'll be right back. And you could go through all your stuff and be like, here's, here's all the science data to validate what I just am telling you. Yes.Lisa Randall Absolutely. And and the reason I know this is that people like you know, Deepak Chopra who've written books about the brain point to all of the science and so you know, I read a ton of books. and I've pointed to these these facts and these concepts in the science through through neurologists and through physicians and through through PhDs in multiple multiple reading. So absolutely, simply through a list of books that I can recommend folks to that they could read and have this information validated.Mischa Zvegintzov Fantastic. Well, thank you for so much for that. So, so So what what's what's the pushback that somebody that would clearly benefit from this from this class? From your techniques your system? Like, okay, so they're like, alright, I get it, like, this illusion that it's too late that my brain can't work anymore. And it's gonna degrade as I get older. That's all BS, like, great. So they're, they're like, Yeah, this is awesome. I see. It can help me like, what's, what's what, what? From someone who's in that position? What's that? What's that? What's the thing that's like, I'm trying to think of how to say this. Like, what's key? Is it their kids that are like, no, don't do it? Because you're going to be spending my inheritance or what's that? What? Like, why else? Like, you know what I'm saying? Like, are they like, well, people, my family is going to look at me like, I'm dumb or like, what? What's the thing that keeps people from like diving in?Lisa Randall Well, and I think that the answer to that question is the answer to the the same question. Why when people know, exercise is good for them? Why don't they do it every day? If people know that eating well is gonna change their life for the better? Why don't they just do it? Right? Why is it hard for us as humans, to change our behavior, and I think it's much less a resistance that's born of an attitude and more of a resistance that's born of it's a difficult, it's difficult to change our behavior, behavior change is difficult. And it's because we're hardwired, how we operate in our minds, and, and changing how we do things, especially the longer we've been on this planet. It's hard. It's, it's altering our ideas, being open minded about trying new things is challenging, and simply changinga  routine of our daily life is hard as well.Mischa Zvegintzov Yeah. Okay. Fair enough. So it's like, it's like, I don't have the time. Or, or I, my lifestyle won't afford this.Lisa Randall Or I want to, I want to make the change, but maybe not today. Or maybe it's not the right time for me, or, you know, the same if someone's wanting to learn a new language or instrument their whole life continues to put it off, because there's going to be a better time. I don't think this is answering your question super specifically. But I think it has a lot more to do with the human challenge around a change in behavior than it does with a specific resistance to this content or this information. I think it's like, why is it so hard, I workout twice, and then I don't want to go to the gym again, the next day, even though they feel so good. It's the same concept. It's just different.Mischa Zvegintzov Yeah, fair enough. Fair enough. What's your favorite? What's your favorite before and after? Of a person that's gone into your...through your program?Lisa Randall I think that, you know, I have a couple of, you know, a couple scenarios that are coming to my mind. But I think that specific feedback that I've gotten from some of my longer term, students and participants has been that ofLisa Randall ...the reflection on how much more they're enjoying the moments that they are creating, how much more they are focused on creating memories that they want to keep. And that's that's been the those are the moments that give me the chills where I think that's is that is it, because who cares if we can remember a bunch of shitty moments strung together right? But if we are focused on being present, and being aware and really valuing the creation of beautiful memories, that's it. What could be better than that? That is that's what I have loved.Mischa Zvegintzov It's beautiful. Do a couple people come to mind for you that where you've seen that.Lisa Randall A couple people have come to my mind where you know they've come back and reflected on hey, you know, I I had this experience with my grandkids and I was you know, usually I come into it worried about this or concerned about that,... but I did my breathing exercises before, and I knew I wanted to remember this, I knew I wanted to remember this moment. And I, you know, I, I knew that if I wanted to, to be able to hold on to these memories, these are the things that I did. And I came into it with a heart full of gratitude.Lisa Randall Because we talk about the emotional state and how the emotional state helps us remember,  So not only are you coming into circumstances and situations, paying attention with a heart full of love, so that cognitively you can remember, you are coming into it fully present with a heart full of love, you're going to have a beautiful experience. And even if you don't remember it, oh, well, you had a beautiful experience of that. I mean, for me, that's what matters, why, uh, you know, even if we don't remember it in the long term if we forget the person's name, but we remember how we felt when we met them, um, really what matters.   Lisa Randall but but these concepts, these components that fill up our "right now" with beauty, those are the same concepts and components that allow our brains to most effectively encode and recall information when we want it.Mischa Zvegintzov It's beautiful. Thank you. Yeah. I want to ask you a question. If I may, another, of course. Good. Cool. So we've got integrative memory, people can go to your site, integrative memory right now, what you have to offer currently is live classrooms, online class, what are you doing? I mean, briefly, butLisa Randall live classes, online classes, I teach several classes a week over zoom. And I have several workbooks that are in progress to support those. I also have a YouTube channel that has a series of meditations for memory of that library of resources online is one that I am hoping to get strategic about in expanding as well.Mischa Zvegintzov Fantastic. Where can people find these meditations on your YouTube channel? It's free for them right now.Lisa Randall It's free for them. Yes. If you just look up and integrative memory on YouTube, it will pop up.Mischa Zvegintzov Fantastic. I will put that link in the show notes. So today your offer is somebody can if someone's like, oh my god, Lisa, I want what you have to offer. They go to integrative memory, they sign up for a class and they get what they get a class for $50? Or what what are they getting right now?Lisa Randall Well, right now I offer I offer an online community class that is donation based. So if they wanted to get a taste of this every Thursday at two, I teach an online community class and that's, that's free to the public, it's donation based. and that's a great way to get started and to get a taste of what I do offer on a regular basis. And so that's where I would send people to start and I would love them to email me directly because I would love to I do offer 30 minute consultations for anyone who's interested in what I do or learning more, and I would I think that would be the best place to start. So then you know, we could have a one on one conversation and I can understand what more specifically they're looking for.Mischa Zvegintzov Fantastic so best email which I will put in the show notesLisa Randall would be Lisa at chunky seahorse.comMischa Zvegintzov Lisa at chunky seahorse.com love it and there's a whole story behind chunky seahorse which is actually rather amazing but we'll save it for another day just trust that typing in chunky seahorse Lisa at Chuck is actually...Lisa Randall adaquateMischa Zvegintzov ...(LOL) but yeah well not only added but affirmation of all that you're creating and have created up to this point. If they want to see if they want to go to your if they want to go to your Thursday at two Pacific Standard Time. Community zoom class. Where do they do that?Lisa Randall Email me yep, I have a newsletter sign up as well on my website. So I have a general newsletter and then one that is focused on mealtimes for memory as well. And then also meditations for memory and that can be subscribed to on my website. but the the Zoom link for my for my Thursday 2pm class if they send me an email I will just respond with the Zoom link for that class.Mischa Zvegintzov Fantastic that's how we're gonna make all this happen. I love it. So excited. And then I'm gonna end with this and we're gonna let you get on to your day cuz I know you've got lots to do. Um, this is like a standing document for you and I.  write?  to be like, Alright, Let's grow together, let's help Lisa you know, grow, bring her gifts, your your, your, your Memory Alive program like let's let's let's, let's apply some entrepreneurial spirit to it even more. and grow it. and evergreen it. and all these terms and and help you create, like financial independence for you and your family and just really help a lot of people right?Mischa Zvegintzov And then it's an opportunity for me to be like, Yeah, I have some ideas, some methods that you and I are going to work together with. And this is our beginning document where you and I can look back at this and go "wow, how far each of us..." Right. Wow, wow. So we're both being very vulnerable for the masses right now. We both have a lot to offer and and I look forward to helping you grow, scale, refine, you know, your story, your message your offer all this stuff and, and very excited.Lisa Randall I'm super excited as well. Thank you.Mischa Zvegintzov Yes, fantastic. Is there anything that we missed that you want to add?Lisa Randall I think you are such a thorough interviewer. I think that we've probably hit a hit all of those those key components. No, but thank you very much for taking the time and I'm really excited about trying to scale and expand.Mischa Zvegintzov Fantastic. Lisa, I love you. Thank you so much for coming on and sharing what you do and everybody check, check back with us. check back in with us as we grow and we will be talking to Lisa throughout her journey and just watching you do all the fun stuff. Yes.Lisa Randall Awesome. Thank you so much. Mischa. This is so fun.Mischa Zvegintzov Okay, love you. I'm going to hit stop. We'll say a quick goodbye. And we'll go on with the day. Okay.

CardioNerds (Amit Goyal and Daniel Ambinder) join Dr. Patrick Azcarate and Dr. Antoinette Birs from the University of California San Diego along with a guest host Dr. Christine Shen from Scripps Health for a hike along Torrey Pines. They discuss a case of a 30-year-old man with a history of malignant thymoma status post two partial lung resections and radiation for pleural/pulmonary metastasis, as well as a history of myasthenia gravis on rituximab, and Ig deficiency on IVIG presents with progressive exertional chest pain. We focus on the differential diagnosis of patients with a history of chest radiation exposure and dive into the complex management and surveillance for patients with radiation associated cardiac disease (RACD). The E-CPR is provided by Dr. Milind Desai (multimodality cardiovascular imaging expert, Director of Clinical Operations, Director of Center for HCM, Medical Director for Center for Aortic Diseases, and Medical Director for Center for Radiation Heart Disease at the Cleveland Clinic). Claim free CME just for enjoying this episode!  Disclosures: NoneJump to: Pearls - Notes - References CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media TTE TTE TTE TTE AP Cranial Pre PCI LAO Caudal Pre PCI RAO Caudal Pre PCI RAO Cranial Pre PCI AP cranial Post PCI Episode Teaching Pearls - Heart Failure with Autism Spectrum Disorder Radiation-associated cardiac disease (RACD) is a heterogeneous disease that can manifest several years, or decades following radiation exposure to the chest and is associated with high morbidity and mortality. Given the non-specific or vague symptoms, one of the greatest challenges for this patient population may be diagnosing RACD which requires high clinical suspicion.  In patients with a history of chest radiation, we should remember to ask three important questions: 1. What was the total dose of radiation given? 2. How long ago was radiation therapy administered? 3. Was the heart exposed?A cumulative dose of >30 Gray (Gy) chest radiation significantly increases the risk of RACD long-term, but cardiac damage can occur at even lower doses. Effects from chest radiation can take years to become clinically detectable. Screening for radiation induced coronary artery disease with stress testing should start 5 years following XRT and in low-risk patients (without risk factors for typical coronary artery disease) and continue at 5-year intervals, and 2-year intervals in high-risk patients. Valvular heart disease surveillance should begin 10 years post XRT and can be accomplished with echocardiogram. Regarding revascularization planning, a Heart Team approach is recommended. However, percutaneous intervention is preferred over bypass surgery in most cases. Notes - Heart Failure with Autism Spectrum Disorder 1. What is Radiation-Associated Cardiac disease (RACD)? A spectrum of disease that can affect any part of the heart and typically develops anywhere from 5 to 20 years after radiation. It may present with non-specific or vague symptoms. Manifestations include myocarditis, pericarditis (typically early in the course) and well as long term sequela such as myocardial fibrosis, valvular heart disease (regurgitation or stenosis), pericardial disease, vasculopathy (CAD), conduction system disease. Radiation may impact any tissue of the heart: Vascular: microvascular, coronary artery disease, macrovascular (ascending aorta) Valvular: has a longer latency ~10-20 years with the left sided valves being more commonly affected; Aorto-mitral curtain thickening/calcification is a hallmark of previous heart radiation and associated with higher mortality  Conduction: Sick sinus syndrome,

In this episode, we talk with the team leading the COVID Recovery Program at Scripps Health. The San Diego based health system is one of the leaders responding to the needs of those with lingering COVID symptoms. Even individuals with mild COVID symptoms could develop long-lasting symptoms. Learn about Scripps Health research into this syndrome. 

"We're Momming Today" with Jen Peters, a mom of three, and former nurse in San Diego, California, whose recent resignation on social media went viral.  Peters wrote: "These shoes were on my feet and this badge was clipped to my chest as I walked into the hospital for my very first shift as a brand new nurse 12 years ago…But this week these shoes and this badge were retired, not by choice but because I refused to get a new vaccine while breastfeeding the baby I suffered 4 miscarriages & COVID while pregnant to finally have in my arms." That baby, Carter, is now seven months old, and Mom Jen is comfortably wearing a new pair of shoes…after her employer, Scripps Health, denied her medical exemption. 

David Lindsay is the CEO of Oncora, a data, documentation, and personalized care solution for specialty oncology. Oncora is currently implemented in many major hospital systems, including Northwell Health, MD Anderson, Mass General Children's, and Scripps Health. David founded the company during his MD/Ph.D. training at the University of Pennsylvania. 0:00 Introduction 1:15 David Lindsay tells his story 5:00 Initial Idea for a company bringing AI to oncology 7:35 When did David decide to start the company 10:25 Balancing being a CEO and a medical student at the same time 12:30 The early challenges in starting the company 14:30 The initial offerings of the company 17:50 Obtaining initial data sets 20:25 Initial funding for the company 24:45 A use case to predict hospitalization 27:10 How are these AI technologies regulated 30:00 How do clients pay for this technology 32:45 Tracking quality metrics 36:00 Integrating with an EHR 37:30 Further development of the product 41:35 Next steps for Oncora 43:55 Industry vs Academia 47:30 Next for AI in 10 - 20 years 48:20 Advice for yourself 20 years ago 50:00 Advice for students in industry 53:30 David's plans for the future Host: David Wu @davidjhwu Producer: Aaron Schumacher @a_schu95 Cover Art: Saurin Kantesaria

Ransomware attacks crippled Scripps Health and Colonial Pipeline. Learn why Colonial Pipeline was able to recover quickly and Scripps Health in San Diego has not. San Diego Deputy District Attorney Ryan Karkenny, a member of the Computer and Technology Crime Hight-Tech Task Force (CATCH) joins the podcast to discuss ransomware attacks, internet scams, the dark web, cryptocurrency, and how to protect yourself using digital hygiene. Read this article by DA Summer Stephan for more information: Ransomware: Don't let bad digital hygiene paralyze your computerEach episode we examine the laws on the books; three are real, one is fake. Can you guess which court ruling is the fake?In Michigan, an appellate court upheld the trial court's admission of Facebook posts in a gang murder case, saying “there is nothing on the face of the posts that would suggest that they were faked or hacked.”The Sixth Circuit Court of Appeals upheld the FBI's monitoring of a dark web child porn website called “Playpen”, saying “the notion that innocent users would be on Playpen is hardly plausible.”The Eighth Circuit Court of Appeals upheld the child pornography conviction of the defendant and said although the agent's laptop was infected with malware, the defendant “presented no evidence in support of his theory that ransomware on the agent's laptop planted child pornography on the defendant's laptop.”In Washington, an appellate court ruled that Bitcoin is a financial asset for purposes of state tax law, saying “Although virtual currencies such as Bitcoin do not generate cash flow for those who hold it, they are no different than other currencies which are considered financial assets."Disclaimer: The views expressed on this podcast are solely of the speakers and do not reflect the views of the Deputy DA's Association nor the District Attorney. Questions and comments can be emailed to crimenewsinsider@gmail.com.Featured in the Top 10 Criminal Law Podcasts!Website: https://sdddaa.net/Facebook: https://www.facebook.com/SanDiegoDDAsTwitter: @CrimeNewsInsidr, @SanDiegoDDAsMusic by: The Only Ocean - "Snake"Image by: Pixabay user Michael Gaida.

The CyberPHIx Roundup is your quick source for keeping up with the latest in cybersecurity news, trends and industry leading practices, specifically for the healthcare industry. In this episode, our host Brian Selfridge highlights the following topics trending in healthcare cybersecurity this week: Major shifts in cyber liability coverages and protections and results from a recently released U.S. Government Office of Accountability (GAO) report Scripps Health system network outage continues a month after initial cyberattack Russian SolarWinds attackers are back at it with a large spear phishing campaign following a compromise of USAID systems Security firm Rapid7 becomes a victim of a software supply chain breach targeting source code OCR's latest settlement details and analysis on the resolution agreement with Peachstate Health Management OCR and HHS “wall of shame” aggregate reporting trends for 2021 and analysis of major reported breaches this past month U.S. House Committee on Homeland Security advances five new bills to improve cyber defenses

Kim Nguyen is the Director of Marketing at Speakeasy Co., an e-commerce and logistics platform that allows alcohol beverage brands to sell directly to consumers from their own website. Kim works to ensure that each brand's e-commerce process and digital marketing outreach is as seamless as possible.  Kim has worked in the digital marketing and paid media space her entire career. Before joining Speakeasy Co., she was the Paid Media Manager at Youtily, a Paid Search Specialist at GoHaus, and the Web Analytics and Email Specialist at Mindgruve. In her free time, Kim enjoys watercolor painting and calligraphy. In this episode… Why are there so many rules to follow when advertising on Facebook? How can click costs impact your digital marketing efforts? What's the easiest way to market your alcoholic beverage company online? Kim Nguyen is a self-proclaimed “Swiss Army Knife” when it comes to marketing — and for good reason. Kim has led digital marketing and paid media strategies for tons of companies like GoHaus and Scripps Health, and knows the ins and outs of click costs, advertising rules, and e-commerce. She's here to share her knowledge and tell you everything you need to know about marketing a brand.  On this exciting episode of Pitcher This!, Darren Fox talks with Director of Marketing at Speakeasy Co., Kim Nguyen. Kim discusses the pros and cons of different marketing platforms, how click costs can affect your strategy, her favorite parts of working at Speakeasy Co., and much more. Stay tuned!

In this episode, Jeffrey Wayland and David H. Wang, MD discuss compassionate extubation. Mr. Jeffrey Wayland is a medical student at the University of Queensland Faculty of Medicine and Dr. David H. Wang, MD is a palliative medicine specialist at Scripps Health.

Jason Interviews Special Guest Wendie Colter, Certified Medical Intuitive, Certified Energy Healing Practitioner, and Certified Transformational Coach.     Our special guest has been a professional medical intuitive for 20 years and is the leading trainer for healthcare professionals.  Based in Los Angeles, Wendie has effectively taught doctors, nurses, psychologists, therapists and energy workers how to use their medical intuition in their practices.   Wendie's early education included participation in Louise Hay's renowned intimate living room healing sessions in Brentwood, California.  Wendie furthered her path by studying various energy modalities including Usui Reiki, crystal healing, transcendental meditation, transformational coaching and NLP.   Wendy is the founder and CEO of The Practical Path, which presents educational programs in metaphysics for professional and personal intuitive development.   Wendie founded The Practical Path to showcase her unique, accredited certification programs in medical intuition for health and wellness.   Wendie is a published author and has lectured and taught at prominent educational and healing centers including the University of California San Diego School of Medicine, Prebys Cardiovascular Institute at Scripps Health, San Diego, Andrew Weil Center for Integrative Medicine at the University of Arizona, and others.    The University of California San Diego School of Medicine recenlty announced their collaboration with Wendie for a research study on Medical Intuition based on the remarkable results of her Pilot Study of graduates for her program.  

Dr. Tim Corbin joins the Integrated MD Care team. He shares his experiences as the Director of Palliative Care at Scripps Health and why working with terminally ill patients is so meaningful to him.     Note: A Life and Death Conversation is produced for the ear. The optimal experience will come from listening to it. We provide the transcript as a way to easily navigate to a particular section and for those who would like to follow along using the text.  We strongly encourage you to listen to the audio which allows you to hear the full emotional impact of the show. A combination of speech recognition software and human transcribers generates transcripts which may contain errors. The corresponding audio should be checked before quoting in print. Transcript Dr. Bob: Welcome back to A Life And Death Conversation. I'm Dr. Bob Uslander, and I'm here today with my good friend, Dr. Tim Corbin, who has recently joined the ranks of Integrated MD Care after working for many years in various capacities as a hospitalist, a palliative care and hospice physician. Tim, I'm excited to have you on the show, and I'm excited to have you as part of our team, Tim. Dr. Corbin: It's good to be here. It's been a journey to get here, and it's a really exciting future for me. Dr. Bob: Well, we've been talking about working together for quite a while now, and timing is everything. Just so listeners are up to speed on you and what you bring to our team, tell me a little bit about your background, your training, and the work that you've been doing up until now. Dr. Corbin: Sure. Well, I'm internal medicine trained through my residency and became board certified in internal medicine. I went into private practice for a few years. I had the romantic vision of being able to take care of my patient completely in my office at home, in the hospital. I realize in the changes of healthcare that that just wasn't practical. It became more difficult at that time to make a living doing that, believe it or not, with insurance changes, and the evolution of HMOs, and all those sorts of things. What I really loved, being in the hospital, taking care of patients who were facing more serious illness and ultimately became a hospitalist as that movement was developing, so spent over 10 years being a hospitalist and taking care of patients in the hospital. But all along I've been doing hospice medicine. There was just a part of me that identified with patients, and I saw that need, and it was very meaningful work, so always a percentage of my practice evolved around caring for patients on hospice and at home. Palliative care became one of the fastest growing specialties in medicine, you know, kind of in the last 10 years. Having done hospital-based medicine as well as hospice work, I was in a position to really gravitate towards that, and it really spoke to the style of medicine that I like to practice, and I again saw a huge need, and so began developing really hospital-based palliative medicine services, and started one in 2008, and then ultimately became the director of the palliative care service at Scripps Health for four or five years. Dr. Bob: It seems like you were in a really well positioned for palliative medicine, being internal medicine trained, having all that experience in the hospital, working with hospice. I think, like me, what you recognized was there's a gap, right? Dr. Corbin: Absolutely. Dr. Bob: There's a gap between treating people aggressively in the hospital and then sending them off to hospice, where the entire focus is comfort and essentially waiting until the end of life. There's this big gap there, where people still need more care. Dr. Corbin: Having done so much care at home, I think I would see in the hospital what patients were often missing. You know, they were receiving their care in the hospital setting, and I always thought about the possibilities of doing some of this at home, where patients prefer to be and can be more comfortable if we had the abilities to do that. That was clearly a huge gap that's been improving, but in my careers, that was a huge gap for families and patients, so I recognized that pretty early on. I always used to joke that hospital medicine, you know, being a hospitalist and internist, strengthened my care, caring for patients at the end of life, but the opposite was true. Me doing hospice medicine and caring for so many patients when they were dying really strengthened my ability to be a better doctor upstream, as an internist, seeing patients in a hospital or even in a clinic setting. Dr. Bob: So, can you expand on that a little bit? Why is that? What do you think that results from? Dr. Corbin: I think for myself, if I'm effective as a palliative care physician, I'm guiding patients through the process of end of life, if patients and families don't recognize that there was a possible issue that could have caused more pain, or suffering, or difficulty, but I've been able to help guide that that never becomes and issue, because I have kind of a prospective insight about what may be coming, and so part of it is a skill of anticipating when we may not have good outcomes or beneficial care and not providing care that doesn't provide that. The way you set what beneficial care is and what quality is is really having those conversations with patients and families so that you gear your care towards what best supports them as a patient and a person. Dr. Bob: Yeah. What they want, what their goals are. Dr. Corbin: What they want. Dr. Bob: It's so true. I think that most physicians who don't take care of people who are dying or who don't see them in their homes, the traditional office-based physician, really have no idea what those challenges are and what's happening with people once they're no longer able to come to their office. I don't fault them for it, but there's a certain amount of ignorance or just lack of experience. They can't anticipate it, which if they can't anticipate it, they can't do anything about it. ` Dr. Corbin: You can take a history and a social history and ask patients, but when you're in the home, and you see for yourself, you see aspects that will affect patients' medical care. Now we're getting in the realm of talking about the social issues and the emotional issues, even spiritual issues. You go in a house, and you can tell a lot about what's important to a patient, and you can immediately identify conflicts and what we're doing medically that don't align with that. Dr. Bob: Right. That don't support that. Sure. Dr. Corbin: In fact, many times I would say, "You know, let me come see you at home next week," and patients laugh out loud, or they're taken aback. They say, "Well, I can come see you in your office." I say, "No. I really want to come see you at home," because I anticipate that later I will need to come to their home–in a fair amount of time–but also, again, it gives me that insight, and there's something about being in a home environment, where you break down some barriers of trust. You can be open with each other to really talk about what's most important. I had a very elderly patient who had a lot of medical issues going on. I thought I was going to her home to talk about that, but her cat kept bothering us while we were trying to have our interview. What it came down to, one of her biggest stressors was, "What's going to happen to my cat? Who's going to take care of my cat?" These things were affecting her ability to make medical decisions about what she wanted and what choices she wanted because she was worried about who's going to help take care of her cat. Dr. Bob: If she were coming into your office, she probably wouldn't feel like that was worth your time, right, to bring that issue up. Dr. Corbin: Right. If I were really an astute clinician, I'd notice the cat hair on her maybe, and I would be able to ask those questions, but I'm usually not that good. Dr. Bob: The second part of that is that someone who's in the patient's home may see the cat, and the cat may come up in conversation, but they wouldn't really be so perceptive or be so concerned about that dynamic, so it's not just the fact that you're there. It's also the fact of who you are. Dr. Corbin: Too often what we see as important to physicians and clinicians is medically based. It's disease based. We don't often think about the social dynamic of patients and how that may affect their health and their decision making. I think that is so true in the hospital setting because patients become institutionalized. I mean, you're giving up your freedom in many aspects, because you become a patient, and you become a patient within a hospital that has certain processes, and rules, and you don't have access to your home. This is something that is tolerated, obviously, by many patients, and we give amazing care, but when you start having patients who that's not really the most appropriate place for them to be, then we have to start creating better solutions than using the hospital as a way to kind of take care of patients who really don't want to be there or don't need to be there. Dr. Bob: Right, or don't need to be there, or it's detrimental for them to be there. Let's segue into that. We'll go back and talk more about what you're doing now because you've made a shift, and you're no longer in that position of running the palliative care and hospice program at Scripps Health, much to many people's dismay over there and joy on our side. But I wanted us to talk a bit about the hospital experience, the gaps that people experience, the challenges, because me, having my experience of being an ER doc for so many years, seeing people coming in various states and conditions, you as a hospitalist, palliative care physician, hospice physician, I think we're in a unique position to help people understand some of the challenges and risks that they face when they are in the hospital dealing with complex illnesses. You can I could spend hours, and hopefully, we will, talking about the different challenges and gaps that people face and ways to help avoid being harmed by them. Well, let's spend a little time focusing on what happens in the hospital, what doesn't happen in the hospital, what happens when people are preparing to be discharged, and where are the gaps, and what can people do to help prevent any further turmoil or challenge? I mean, you mentioned when you're in the hospital, you're in an institution, right? You're in their territory, so you lose some of your freedoms. I think that people who work in the hospitals, they lose sight of that. I mean, they're busy. Everyone's working hard. No one's lollygagging around, for the most part. I will make generalizations. In general, I think that people in healthcare really do care. They really want to do the job, and they really want to take good care of people, so it's less of a personal personality issue, and I think more of an institutional system problem, that we just don't have enough staff. We don't have enough people to provide the kind of personalized, supportive care that people are looking for and need, and that's largely a financial issue, right? I mean, what's your perspective on that, having spent so much time in the hospital? Why don't people feel, in general, like they're well cared for? Or do you think that they do? Dr. Corbin: I think in many cases they do, and in many cases, they don't. I think one of my family members, in their personal experience, made a comment that in the hospital they felt like they were a cog in a wheel, where there's this path of workup, and diagnosis, and treatment that is on a course of, you know, kind of standard medical treatment that, again, a patient gets put into. A patient's in a bed. The physicians discuss having, "Well, we need to get a CT scan." It's ordered, and all of a sudden someone shows up to the patient, and they're whisking them to the radiology, and the patient doesn't understand why. When you sign yourself up in a hospital, you're signing yourself up and agreeing to the treatment that needs to be done for your particular issue. As physicians and clinicians, we're trained to treat that condition. You know, there's kind of a process and an algorithm to that, to a certain extent, and we don't often go off course. To not do something could risk missing a diagnosis or risk of there being downstream harm, and physicians are very sensitive to that, whether it's from the standpoint of malpractice or not providing a standard of care. The standard of care becomes doing everything, which is not always appropriate. It's not always beneficial care. I tell you, patients often recognize that, and they understand that and are willing to take that risk, if you will, so there becomes this disconnect between what the treating teams are doing and what the patients really want. The patients, it's not that they don't want to be hospitalized. They may say, "You know, I'm weaker at home. I'm 90 years old, but my quality of life's pretty good, so I don't mind coming in and getting treated for pneumonia, but I'm not really up for getting a bunch of CT scans and being poked and prodded and this sort of thing," so where is that balance? In many ways, it's the physician's job to cure and to treat fully, but we're not always taught how not to do everything, so I think patients need to recognize that. There are many times patients bring up the fact and want to have this conversation. So, in the last 10 year, palliative care teams have developed in the hospitals, which are multidisciplinary teams made up of physicians, and nurses, and social workers, and even chaplains to really address patients' emotional, social, spiritual needs, as well as their physical needs, but really it developed as a support team to help support patients with serious illness through the hospitalization, which is kind of crazy when you think about it. Our technology and ability to treat patients is so, you know, high tech and the ability to keep patients going and keep patients alive is so extended that we need support teams to help- Dr. Bob: To protect them. Dr. Corbin: ... to help fend off, you know ... It's kind of like the ability to turn off your cellphone and ways for patients to connect with you. It's very interesting when you start thinking about the ... I always joke that I hope I don't have a job as a palliative care doc one day because that means that our healthcare system is treating patients with the values and the principles of palliative care that we don't need specialists in palliative care to do this. I think we'll always need our expertise and specialty, but there's so much work to be done in that realm of taking care of patients holistically. Dr. Bob: So, a huge issue that we touched on is that when people are in the hospital, sometimes the care is appropriate, and then there are times when it just goes beyond what they would want or might seem necessary because that's just the way it's done. My sense is that it's the path of least resistance. A person is in the hospital. They've got a condition. Something else might be identified. Then they get a consult with the kidney specialist, and they get a consult by the cardiologist, and a consult by the infectious disease guy, and the pulmonologist. Everybody gets a piece of this patient. Everybody gets paid, but everyone's ordering the tests that they feel are appropriate, potentially the treatments that they feel appropriate, and then before you know it, there are six different physicians treating the patient, and they're now a week into it, and they've been tested and treated way beyond they may have ever wanted, because those conversations are not happening. Dr. Corbin: Let's think about each of those physicians who are seeing those patients, who are amazing clinicians, really good docs, want the best for the patients, want the best outcomes, so intentions are all perfect and good, but in today the chances that any one of those physicians has a long-term relationship with that patient is almost zero. We now have sub-specialists, who do nothing but round in the hospital for their group. We used to have just hospitalists. Now we have cardiologists that are hospitalists. We have GI docs that are hospitalists. We have neurologists that ... when you get admitted to a hospital, you have this new team taking care of you, and no one has had that relationship over time. If you, as a patient, have defined what is most important to you and what your true goals are for your life, what gives you dignity and respect, and how you want your life to go as you become sicker, no one has appreciation for that. That's one reason we have palliative care teams, because we sit there for three hours and try to understand this, so we can affect what we decide to do with patients. If you don't have those conversations, as my family said, you become a cog in a wheel, where we're going to treat whatever's going on as we do everybody, and there are tremendous pressures to then get you out of the hospital. You know, we always want a shorter length of stay. Dr. Bob: We do everything- Dr. Corbin: When I first started as a hospitalist, patients stayed in the hospital five or six days. Now it's down to below four days, three days average length of stay. Tremendous pressure to see patients, make a diagnosis, start treatment, and then get out of the hospital. So, you don't have the luxury of time to sit there and think about what you want, or you don't want, because people are coming up to you constantly saying, "We need to do this next and this next." So, it can be completely overwhelming. Families and patients get in a crisis mode. You know, I tell families and patients, "It's really not a good place, in a hospital, to be making life or death decisions, when you're in a crisis mode, where you're emotionally stressed. You haven't been sleeping well. Family's flying in from out of town everywhere, and you're being asked to make decisions that hugely impact what your future is going to look like. You really need to try to have these conversations earlier." Dr. Bob: Very critical information, the timing of that, when you do it, but a lot of times it's not being done. Dr. Corbin: Absolutely. Dr. Bob: So, we now find people who are facing this. They're in the hospital. They're being asked or kind of demanded to make a decision about what's next for them, which may mean going home with certain treatments. It may mean going home and being in hospice. It may mean going to a nursing facility. But they're being pressured, because of what you were just describing, where there's pressure on the physicians to discharge patients and get them out of the hospital quicker, which in some cases is appropriate, but it puts this new sense of time pressure on families to make decisions, and they're getting it from the hospital discharge planners, and the case managers, and now the doctors. So, what do you do? Dr. Corbin: Yeah. You started this conversation talking about gaps in care. I think the gaps are that, you know, our healthcare system's kind of in silos. You see your primary doctor. You go to specialists. When you're in the hospital, you have your hospital team. When you leave the hospital, you may go to a facility, like a skilled nursing facility, which has its own team. So, the patient needs to speak for themselves. We talk about healthcare now should be more patient-centered and family-centered, where the patient should have the autonomy in decision making to make decisions that are best for them, but they're constantly facing a new team. I once looked at social workers' touches on a patient who had cancer very early in their diagnosis all the way through to the end of their life, and they had five different social workers over the course of like a two year period. You know, they had a social worker, outpatient oncology social worker. They had a home health social worker. They had a social worker in the hospital. The palliative care team had seen them eventually, and they had their own social worker. When they ultimately went home on hospice, they had a different social worker. So, you can see that families and patients sometimes complain about having to tell their story again, because they're constantly having to tell their story again– Dr. Bob: Over, and over, and over. Dr. Corbin: ... and reiterate what's most important to them. You know? It's almost like telling my story fatigue. They just get tired of that. So, there are the gaps where there's not that support. Dr. Bob: The continuous support, the continuity. Dr. Corbin: And often it's about explaining to families and patients what their options are and how to be prepared for those things. It's much easier to do it when you have a little bit of time and space. It's very hard when you're told, "You need to figure this out within two days, because they're being discharged in two days, and we need to know if they're going to a skilled nursing, or are they going to go home with more support, or whatever the case may be." Then patients often, depending on what kind of support they need, they may ... For example, hospice, which is by definition for someone whose prognosis is estimated to be less than six months of life. With that, you get a hospice service, and you get kind of this comprehensive care that's paid for through a hospice benefit. It's great support. You have 24-hour care for nurses, a triage available. They can come to the home as needed. Medicines are often delivered to the patient. You have a social worker, physician's visit, do home visits. I mean, it's an amazing program, but it's for the more very end of life. I see a lot of patients who are kind of really I wouldn't say pushed, but one of the options is to go to hospice when maybe it's questionable whether they may qualify. It's questionable whether that's what they truly want. They're not maybe ready for that, but they get the support because everything else is breaking down, that they're kind of pushed towards that, and then patients get better because there's not another alternative. The alternative home is often home health, which doesn't give the same amount of support. If patients' preferences are to get home, one of the huge gaps is enabling patients to get home with the kind of support they need. By default, if we don't have that, they have to go to a skilled nursing facility many find it very difficult to participate, but they're supposed to participate with a certain amount of therapy. They prefer to be at home. You look at a healthcare system that's looking at ways to be more cost-effective and to give beneficial care. You know, you have a situation where patients prefer to be home. That's where they want to be, yet there's no infrastructure to support that, yet it's inexpensive care when you compare it to a skilled nursing facility, or you compare it to going back in the hospital, and yet we haven't, as a healthcare system, figured that out yet. There have been improvements there, but it's a gap. It's a problem. Dr. Bob: Yeah. I think one of the reasons that it continues is because the people who are making the recommendations and facilitating the discharge, physicians, discharge planners, case managers, they have a hard time thinking outside the box. They're looking at what is the most efficient. They're looking at multiple factors. They're looking at what's in the best interest of the patient, what's going to allow them to get the patient out most efficiently because they have pressure to discharge the patients, and then what they're familiar with. How do you facilitate it? Unfortunately, what's in the best interest of the patient or what's most aligned with the patient's goals and values drops down the list of priorities, and people, patients, and families don't know to question it. They don't question the doctor. When the doctor says, "You need to go to a nursing home," well, that's where you need to be, but many times, as we both know, that's really not what's in the best interest of the patient or the family, and so everyone continues to struggle. Dr. Corbin: We should always question, as patients and families, if possible, just not question, but understand. If I'm going through a test or if I'm being sent somewhere, you know, why? What's the purpose, and what is the outcome, and what's the endpoint? What is my goal? I often tell patient and families, "Let's understand who you are as a person, as a patient. What's most important to you? What gives you the quality of life and meaning? And let's align the medical care we provide and the support we give with those goals." It's approaching the patient from a completely different perspective than what we're really taught in medical school, which is really disease based, you know, history and physical, if you will. Diane Meier, who's a leader in palliative care, had a quote. I don't know her exact words, but basically, she said, "You know, palliative care is about matching patients' goals with the medical care we provide." Dr. Bob: It needs to be driven by that, and it's not. And patients still, especially the older patients that we get to take care of, they're intimidated. They don't feel empowered to question what's going on. They may, in some cases, and sometimes there's a family member who will stand up and advocate, but too seldom does that happen. We, I think you and I recognize these gaps. We're working towards trying to fill them in our way, in our community, but what I'd like to do is to give a couple of, I guess action items, a couple of things that people can do to take away from this discussion when they have a patient, a family member, or themselves admitted to the hospital who is then going to be discharged. What are the couple of things that we would recommend that people could do? I'll start by saying, in general, if possible, you should never allow a family member to be in the hospital alone. Whatever needs to happen. And I know it's not always easy. It can be very challenging. Sometimes it's costly, but when a person is in the hospital, they are sometimes sedated. There's the potential for medication errors. I had just a patient who was a 31-year-old woman, who was on pain medication for an intestinal disorder that made it so that she couldn't eat anything. She was being fed through feedings going through her veins. She got an infection. She was hospitalized. A well-meaning nurse, but a relatively new nurse, instead of giving her five milligrams of Methadone, gave her 50 milligrams of Methadone, which is a huge, potentially fatal error. Those types of things happen all the time. It's not just the errors. It's the feelings of loneliness, of isolation, of needing to get somebody to come in and help you get to the bathroom, to understand what the doctors are saying when they come in on their rounds, which could be whenever. People need advocates, and I will never allow a family member of mine to be in the hospital at any point without somebody there to advocate for them, so I would strongly encourage people to find a family member, friend, or even if you have to to pay someone to be there with you. Dr. Corbin: Yeah. I would agree with that. You know, things in the hospital happen fast. We used to round as a team once a day, get all our tests, round the next day. Now we're rounding multiple times a day on a patient. You'll round, get some tests. You'll round again in the afternoon. Things happen quickly, so for a family to get real-time information is challenging if you're not there. I also tell families, "You know your loved one best. What are you seeing?" Subtle confusion or changes in their cognitive abilities, which is very common when you're hospitalized, particularly when you're older, may be missed by someone who doesn't know the patient. If you treat that early, you can kind of help prevent some of that, so there are lots of reasons to have an advocate for a patient there, for sure. That's one of the risks of hospitalization. I mean, it's well documented, medical errors, and hopefully, there's been an improvement in protocols, but the reality is is that, again, you're institutionalized. There are processes, and as much as there are checks and balances to avoid mistakes, mistakes can happen that can cause harm. It's been well discussed in medicine as an issue in our healthcare system, as well as infection risks, and often hospitalization tends to lead to more treatment. One thing leads to another, so you have to define what your purpose is in the hospitalization. You may know this. What an ER doc told me once, "As soon as a patient comes into the ER, the first question I have, 'Am I sending them home, or am I admitting them?'" I mean, that's the first question they ask. You know, as a hospitalist, I would say, "Okay. When am I discharging this patient?" It was all about the discharge. It's, "What do we need to do to get the patient out?" That doesn't mean we're not concentrating on treating, but there's such pressure to get patients out. So, another thing of having someone be there with the patient, be an advocate, is really advocating for what the vision of the patient needs to be in transitioning out of the hospital, back home or wherever that might be. Dr. Bob: Right. You alluded to this, the experience and the perspective of an emergency physician, and I think another tip for people is really thinking about whether you need to go to the emergency room or not. Give some serious consideration to that, because when an elderly person or a person with complex illness ends up in the emergency room, it's far easier to admit them to the hospital than to discharge them. Whether that's in their best interest or will ultimately result in improvement, or the opposite becomes kind of secondary. Speaking from the perspective of a physician who worked in the ER for 20 years, when an ill or elderly person comes in, ideally we could assess what's going on, determine what needs to happen, and determine if we can safely allow them to go home, which is where they'd rather be, and in many cases that's the safest and best thing for them. But because that takes more time, energy, and puts more risk on us as a physician, the path of least resistance is to call the hospitalist and say, "I've got a 95-year-old who's maybe got a touch of pneumonia and a little fever," and they might fight you, because they don't want to do another admission, but you're going to push that. Then you're going to order all the tests and order all the x-rays to cover yourself. So, there are times when we pick up things, and that kind of a workup and approach is valuable, but there are many times when it's not. Dr. Corbin: Another thing for patient families to realize, is that most physician offices are open from 8:00 to 5:00, but it's often 9:00 to 4:00 or something like that. After hours, and weekends, there's more chance that you're going to have an issue off hours than you are during regular business hours. Our human bodies function or not function 24/7. But one question for patients and families is, "What do I do after hours or on weekends if I have a medical problem?" Unfortunately, by default, if there's an issue after hours, and if you have any kind of significant medical history with advanced illness, no one's going to take the chance that something is missed–so they say, "Go to the emergency room," or, "Go to Urgent Care." That's just what we do. We impact our emergency rooms. It's very expensive care. Most of the time, if you have significant illness, the ER doc's going to feel uncomfortable sending you home, because they don't know you, and it's complicated, and so you end up getting admitted. As a hospitalist, I felt I did a lot of admissions, which were unnecessary. If someone was there to coordinate care at home, and kind of have an oversight, and there was that plan of what to do if it was after hours. That's amazing thing of your service with integrated MD care is that someone who has that layers of care, you know, all this is kind of planned out, and you have that support, and patients are really satisfied because you're not just ... Patients aren't just being sent back to the emergency room, and you get, again, into that cog wheel of treatment, where many patients don't want to be, which is another point. One of the risks of hospitalization is when you go, the medical records, you know, your history, what's been done, there are often duplicated care. You get more imaging tests, and you get more workup that you don't really need. I really advocate for patients and families to take a medical history and have that with them. If you come with a full binder, no one's going to look at it or read it, so it needs to be kind of done by someone with some medical knowledge to very succinctly put the diagnosis and what treatment's been done, so it's well understood, because- Dr. Bob: A summary. Dr. Corbin: We just reinvent the wheel. Again, this new team takes over, and they're kind of obligated to do the workup, and it's probably, in many cases, already done. It doesn't seem like a big deal, until you're in that seat, or you find those tests to be very difficult to get through. You know, to go through an MRI, if you've ever had an MRI, it's not a fun experience. I've had one, generally young and healthy, and it was really tough. Imagine if you're in pain, or have more advances illness, or if you're elderly going through these tests. We don't think about it. We think to go to the hospital; you just do what you need to do. You get these tests, but we don't understand kind of sometimes the physical and emotional toll that that takes on you. Dr. Bob: It's very easy to order the tests, right? It's very easy to order an MRI, or a scan, or another blood test, but even just getting blood drawn, these people, the folks, they're sick. They feel horrible. Dr. Corbin: I used to challenge my ... I used to come in as an attending, whether I had residents or teaching. It was like day number seven of hospitalization, and they had the same blood panel every single day. I'm thinking, "What are you going to see in this blood test that may change what we're doing in management?" I mean, we get in this protocol where we stop thinking critically, and we just start treating patients as a process, and- Dr. Bob: Yeah. And a commodity. Dr. Corbin: It's easy to do. You referenced it earlier, about how when you work in that environment, it's comfortable to you. You know it. When you're not in it, it's over. I remember the first time as a medical student I walked into an intensive care unit. I kind of stood back, and it was just kind of a, "Wow." It was kind of overwhelming. Well, you know, when I was a resident, and I spent a whole month being an attending resident in the ICU, after that month it was ... Even after a month it became pretty routine, and all those bells, and whistles, and machines, and tubes, and everything else became kid of normal, which is kind of scary when you think about it, but you've just kind of normalize to that. We always have to back up and understand it. That's what's so hard to have these conversations with patients and families, to really get them to understand what things may look like as they make different choices about their treatment. I say, "There's no right or wrong answer about the treatment." I think patients need to understand their choices and make the decisions that are best for them, and then we try to support them in that decision. I think to have a good history available with you, be prepared with what your true goals are downstream, so you can share that information with physicians and teams, if you change different healthcare settings, and then really having someone that can really coordinate that care for you. If there's someone in the family that can't do it, and you have the means to have someone else or hire someone to help coordinate that care, just like having someone be with you in the hospital, there's no doubt you're going to get better care. Dr. Bob: Yeah. That's critical. Unfortunately, I think once you're in the hospital, it's hard for outsiders to come in. You might have that. So, for me, we do this high level of in-home care and become very intimately connected with our patients and our families. We do a great job of keeping them out of the hospital, because we are available 24/7, and we address things as they come up, and we really try to encourage people to not just rush to the hospital. In general, we're pretty successful at that, but sometimes people end up in the hospital. Even though I have this very intimate relationship and the patients want me and my team to be engaged, the hospital doesn't want that. They don't want outsiders coming in, and it's very difficult to get much information. I'm able to communicate with the hospitalists with some effort, but you can't coordinate anything. It's very difficult to influence the care that's happening, so you have to be able to work with the families, to spend some time with the patients, and allow them to become self-advocating as much as possible. Then get them the heck out the hospital as quick as possible, right? Let's talk for a moment about palliative care, because it really can add a lot of value to the experience for people in the hospital and save them from some future struggles and help guide things more in alignment with their values and wishes. Is palliative care available for every patient in the hospital, or how does somebody get a palliative care team to work with them and support them? Dr. Corbin: That's a very good question. Palliative care, first off, is really available to any patient at any time in their medical illness. It's a whole-person, holistic approach to care, where we address patients' physical needs, but also, as I mentioned, emotional, social, and even spiritual concerns, and try to align our care with what their true goals are for themselves, knowing that those goals may change with time. So it's a fluid situation. But it's really having those conversations and supporting those patients in that goal. It's a team approach, so it's a physician, and a nurse, and a social worker, and often a chaplain, and also maybe sometimes ancillary services as well, so it's a team approach as well. There's a lot of talk the last year that unfortunately palliative care, someone gets palliative care by chance. We know that palliative care is beneficial. We know it enhances the quality of life. We know patients like it. There's less caregiver stress. There's better end of life experience in death when that time ultimately comes. Patients can tolerate their medical treatments better when they have palliative care involved. We know all the outcomes look really good. Palliative care across the board is inaccessible to all patients in every care setting, and so it becomes who do you know? It's, "Oh. Well, I know my neighbor's Dr. Corbin, who does palliative care. Maybe you can call him," and so, oh, I get involved. It's kind of word of mouth and by chance, which is fortunate. Hopefully, in the future, we get palliative care across the spectrum. Palliative care started in a hospital setting, and now over 70% of hospitals in the country have some sort of palliative care team. For example, Scripps Health has palliative care team at all five or their campus and hospitals. So, patients in the hospital can request palliative care consultation. Usually, it's up to the attending physician, whether that's the specialist or the hospitalist, to request a palliative care consult. Dr. Bob: Can a patient or family request a consult? Dr. Corbin: It depends on the hospital. For example, at one of my hospitals, where I started the palliative care team, we made it so anybody could request a palliative care consult, family, the patient. It doesn't have to be from a physician. In that setting, we sent a nurse in to really evaluate the situation, to see what was happening, and then to talk to the attending physician and say, "Can palliative care ...?" But it was a real challenge, in the beginning, getting in the door. Dr. Bob: I would imagine. Dr. Corbin: In many ways, we're seen as a threat, or we do another layer of care that then can be seen as getting more complicated, but the reality is is that we're working through all these issues that really are not discussed. So, that's in the hospital. Most hospitals have palliative care, so if there's a desire to have palliative care if you ask. Often you can look online or read about the hospital, and they advertise their palliative program. The big gap is outpatient palliative care, so what happens to the patient when they go home? If they go to a skilled nursing facility, most likely they don't have palliative care. If you go home, most likely you're not going to have home palliative care, although there are some programs that exist now. There are different levels of what that means. So, if you've seen one home palliative program, you've probably seen one home palliative home program in terms of structure. Some are just nurse-driven. Some are just physician-driven. Dr. Bob: Or physician assistant, but none of them have figured out the model so that they can really deliver. Dr. Corbin: And the barrier's really been about reimbursement, who can pay for that. Unfortunately, that hasn't been figured out. There are trends now with private insurances, as well as possibly even Medicare, starting to pay for kind of more home palliative kind of bundle payments towards that, which will hopefully gain more access. Dr. Bob: Apparently Medi-Cal, which is the California Medicaid program, as of January 1st, is now paying for some version, some form of palliative care. Dr. Corbin: I know Blue Shield of California is paying for home palliative services for some of their patients they identify that need that. So, the other is outpatient palliative care in clinics. Now that's the third tier, so it's been kind of hospital-based, an attempt to do more home-based palliative care, and now actually doing even farther upstream where patients in a clinic setting can get palliative care has been pretty rare. I started an outpatient palliative care clinic at Scripps, which we ran in a radiation oncology center, which is a great setting, and I saw patients in the clinic just to kind of see patients kind of farther upstream. The powerful thing of that is that we were having these conversations not in the hospital when you're in the crisis mode. Because what happens? You can have all of this great plan and this great conversation in the hospital and know what you want to do, but as soon as the patient leaves the hospital, it all falls apart, because there's not the infrastructure or process to support it. You go back into the same process of delivering medical care that we do, which is going to your primary office, going to your specialist, and after hours, if you don't have availability, you go back to the hospital. How do you break that cycle? Dr. Bob: Your family was trying to figure out how to find the right resources for you. Dr. Corbin: So, seeing patients in a clinic upstream is extremely powerful. I would encourage patients with any non-curable illness, whether that's heart failure, or early dementia, or Parkinson's Disease, or an advanced stage cancer,–even if you're getting full treatment, you expect to get treatment, your illness will hopefully be well controlled for years to come–still you should have a palliative care type conversation with a physician or a team that understands the longterm vision. One, you start to have conversations that you don't want to have in crisis mode, or you don't want to have way down a couple of years from now when you're being admitted to the hospital. That's not the right time to have these conversations, to really, truly know what you want. It also relieves this burden. It's always the elephant in the room, you know, what do I truly want, and having these conversations. Frankly, having conversations about death, and what it may look like, and what your preferences are if you do that, it's not threatening when you do. If you do it when death is a real possibility– Dr. Bob: Death is looming. Right? Dr. Corbin: ... it's incredibly frightening and overwhelming. Dr. Bob: For everybody, including the physicians. Dr. Corbin: Including the physicians, so by fault, we don't have that conversation. So, the patients that can have these conversations, and they want ... Studies suggest that patients want to have these conversations. Dr. Bob: And experience would confirm that. Dr. Corbin: We just don't do a good job, as physicians or clinicians, having those conversations. We just don't want to have the conversation. Palliative care in the hospital, there is some in the outpatient clinic. For myself now, I have two days a week where I do outpatient palliative care, where I can see patients in a clinic setting. I'm working within an oncology group, but I'm open to more than just oncology, so if patients know about me, they can come and see me. The purpose is to say, "Hey. What's going on medically? What's going on in your life? Where are your stressors?" You know, I ask patients, "How do you feel your quality of life is? What is your distress? How are you sleeping? How are you eating? What are you eating? How is your nutrition? All of these are things that we generally don't talk about with patients. But it's all about how can we identify things that are important to you? I had a younger patient, with advanced cancer who, after a long conversation, two things in her life were missing. One, the ability to still do yoga, and two, she had some experience with acupuncture, and she was interested in trying that again, but she was kind of bummed that she tired and couldn't do yoga anymore. Through connections, and friends, and again, palliative care by chance, I called a couple of friends, and one goes once a week now to help her do restorative yoga, and another goes once a week to do acupuncture. She's just thrilled. She's thriving. Her tumor markers are decreasing. She's responding to her chemotherapy. Her sense of wellness is much better than what it was before. She has hope. She's confident. She's living with her cancer better. I guarantee you in a normal healthcare environment, that would never come up. If she didn't seek palliative care, no one would ever have the conversation about setting her up with home yoga or acupuncture. It just doesn't happen. Dr. Bob: It sounds like a great concept. I kind of wish I had thought of that. Dr. Corbin: And you did. You know, what you do, the services that you can provide through integrated MD care, for example, the music therapy or aromatherapy, or massage therapy, or acupuncture, many patients don't think about that being important, but it's incredible how that can help you tolerate treatment better, reduce stress, take away some of the fears that you have. Ultimately we're deciding what are you afraid of. Is it what's coming tomorrow? Do you make up a story in your mind of what your future's going to look like, or you make decisions based on that fear, or you have conversations about that? Do you understand the facts medically, from a physician and have someone who can tell you, "This is most likely what will happen, and there's evidence to support that,"? And you get rid of this stuff we make up that scares us, and then you start to trust yourself. You start to trust life to give you what you need, and patients start to respond to treatment and can tolerate things at a whole other level. Dr. Bob: If those things that would enhance your life, and those people, and those therapies are presented to you and through trusted sources, and you open yourself up to them, I've seen, as you are expressing, I've seen tremendous, tremendous transformations in people. I've seen people, who had a prognosis of a month, and they were being told that they've got a month or six weeks to live, open themselves to receiving these therapies and ultimately live for a year and a half with an incredible quality of life. The reason for that, it's multifactorial. Part of it is the actual therapeutic benefit. A lot of it is just this connection that happens with life through other people, who are there to reach into your spiritual being, to help bring out the joy. So, that's a powerful, powerful thing that there's really no way to really put any kind of value on. Dr. Corbin: It's really taking your life back from whatever disease you're dealing with. You think about it, you know, you're whole day. I saw a patient yesterday who wanted to come to my clinic, but he said, "You know, but every single day I have a doctor's appointment for the next two weeks. I don't know if I want to come see ..." I mean, your life revolves around testing, and diagnosis, and treatment, and you lose the things that were important to you, like yoga and massage therapy that you used to do. Dr. Bob: Or time with your grandchildren, or time at the beach. Dr. Corbin: Or time to read or whatever. So, if we can challenge patients to make space for that and to remain who they are as a person through their treatment, it's invaluable. You know, unfortunately, I was never taught that in medical school. We're not taught how to take care of that aspect of patients. It's been, you know, over 20 years since I've done that. I think the medical education system has responded to that in many ways, and it's getting better, but the reality is is that we don't ... We talked about this earlier. I'm taught how to do a history and physical, and the things that I ask in my social history, like, "Do you smoke? Do you drink?" You know, those sorts of things, but I'm not taught, "What is most important to you? How is your stress level now? How is your nutrition?" We just don't ask those questions. Dr. Bob: Yeah. Certainly not, "Where do you want to be when you die? Who do you want to be around you?" Because for me, and for you as well, the idea is starting with the end in mind. If you can get people to share what that experience, how they would like that experience to be, it tells you a lot about who they are, and then you can help to guide all the care that happens. Dr. Corbin: That conversation intertwines a lot of spiritual, religious, philosophy, all of these things, right? But it's not about that conversation. I mean, I can have a very religious person or a very spiritual person who still hasn't truly thought about the way they want their end of life to look like. Sometimes who I think might be the most religious or spiritual person struggles the most with that decision, because they haven't thought about it in the context of that. No matter what your belief system is, no matter what your support system is, if you're challenged to think about it, it's an exercise we should all do. Dr. Bob: And people will often spend a lot of time thinking about how it should be for others and what they're comfortable with, and what they believe. But it's very difficult for many people to actually go down that path and take it to the point of imagining and trying to identify what's most important for them at the time of their death. Dr. Corbin: So, we've covered a lot. Dr. Bob: Yup. Always. Dr. Corbin: We've touched on a lot of issues. I think, hopefully, this is really valuable for people to get some real, heartfelt discussion from physicians who have been right in the fray. Right? I feel like we have a kinship here. We both love medicine. We both love medical people. We have a lot of respect for the passion, and the heart, and the compassion of healthcare providers. We're sensitive to the fact that they are often working in environments that don't allow them to practice optimally, and it gets very frustrating and discouraging. We see how wonderful the medical technology is and what it can do for people, and at the same time, we see how that has created this propensity to use that technology, and wield it un-responsibly, and neglect sometimes what's really and truly most important to people which can be to encourage them to take a different path. Dr. Bob: We have a lot of experience. Hopefully, we've shared some things for people to think about, and I think we're going to have lots of opportunities to continue exploring, discussing the pros, the cons, the good, the bad, but I'm excited, because we, in our practice, get to fill the gaps. Dr. Corbin: Absolutely. Dr. Bob: That's why we started Integrated MD Care. That's why we're doing this podcast. That's why we're doing a lot of the things is we're responding, we're taking a risk, right? Dr. Corbin: Absolutely. Dr. Bob: We're stepping outside the norm, and we're facing some folks who don't quite understand what we're doing, how we're doing it, or why we're doing it, but I think we're both committed to the process and to serving people at the highest level. Dr. Corbin: Absolutely. I agree. At the end of the day, we need to listen to the patient, keep the patient in the middle, provide patients with the best quality and beneficial care, and that really comes from talking to the patient and understanding what gives them the most value. That's what it's all about. Then we need to help continue to push our healthcare system to give the infrastructure to support patients with that. It's really exciting to see the work that you've been doing, and the outcomes that you've had with patients and families and really helping patients be able to transcend those gaps to get the perfect alignment of care that they deserve. You know? And making it not about palliative care by chance or this type of care by chance, because someone happens to know you, but really hoping things like this podcast will start to trickle out there, so patients are aware of what is available. Hopefully, we'll push the expectations higher, and our healthcare system will start responding to that. Dr. Bob: Yeah. That's our goal. Dr. Corbin: Look forward to it. Dr. Bob: In the meantime, we're doing it, and we're letting people pay for it, to recognize the value that they receive. The non-profit foundation that's just been created, Integrated Life Care Foundation, will help to provide funding for people to receive this level of care when they don't have the resources to do it. I'd like to now officially welcome you to the Integrated MD Care team, as one of the providing physicians and one of the leaders of this movement. Dr. Corbin: I look forward to it. A lot of work to be done. Dr. Bob: Absolutely. Thanks for coming on the show, and we'll be connecting again soon.

Dr. Steven Steinhubl has a long and impressive array of leadership activities across health. He has held numerous positions as an educator, researcher, and clinician at hospitals including the Cleveland Clinic, in the Air Force, and within Geisinger Healthcare system. With over 200 peer-reviewed publications, book chapters, and abstracts, Dr. Steinhubl is currently the Director of Digital Medicine at the Scripps Translational Science Institute and a clinical cardiologist at Scripps Health. Dr. Steinhubl received his undergraduate training in chemical engineering at Purdue University in Indiana, graduate training in physiology at Georgetown University in Washington, DC, and his medical degree at St. Louis University in Missouri. In this interview, Dr. Steinhubl discusses the potential of mHealth and digital health working with Dr. Eric Topol, as well as payment reform.