Latest / Becker’s Healthcare Podcast / Ryan Ribeira, MD, MPH, Medical Director and Clinical Assistant Professor at Stanford Health Care

Transcript

Ryan Ribeira, MD, MPH, Medical Director and Clinical Assistant Professor at Stanford Health Care · Becker’s Healthcare Podcast

• 0:00
  Hello, everyone, and welcome to the Becker's Healthcare
• 0:02
  Podcast. I'm Scott King. Thrilled today to be
• 0:04
  joined by doctor Ryan Rivera, medical director and
• 0:07
  clinical assistant professor
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  over at Stanford Health Care. Doctor Rivera, how
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  are you doing today? I'm doing alright. Thanks
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  for having me. Of course. Thanks so much
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  for joining us. We have a lot of
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  big topics and and trends in health care
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  to get to. But before we get to
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  the questions, I was wondering if you could
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  please tell us a little bit about your
• 0:24
  background.
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  Sure. Yeah. Yeah. So, you know, as you
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  stated, I'm an emergency medicine doc. I'm the
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  medical director of the adult emergency department over
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  here at Stanford. But I think maybe worth
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  noting that I've, my whole career, I've kind
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  of straddled a a few different spaces. So,
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  you know, came up as a resident at
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  Stanford, did administrative fellowship here, and obviously continued
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  on in, traditional health care operations. Got a
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  master's in public health focused on administration as
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  well.
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  But also have spent a lot of time
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  in the tech industry. I I used to
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  be a program manager over at Google. I've
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  been part of a number of,
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  health tech start up companies along the way.
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  And then,
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  currently, I'm also the medical director for digital
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  health for acute care here at Stanford Health
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  Care and also run kind of our industry
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  partnership program as well.
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  So we've kind of viewed things through both
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  lenses. How can we use traditional operations
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  to expedite throughput and improve care? And then
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  also how can we leverage technology, especially in
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  the current environment to do those things better.
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  When you see how emerging tech has kinda
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  taken health care by storm, are you really
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  glad that you you spent some time in
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  that space before you got to where you
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  are now?
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  Yeah. Absolutely. I mean, every
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  one of the things I like about technology
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  is,
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  it's it always seems like you're just right
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  there on the bleeding edge of some really
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  cool stuff. And so, you know, right now,
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  it's it's AI,
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  obviously, but, you know, previous to that, it
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  was telemedicine. And, you know, previous to that,
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  it was clinical informatics. And so,
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  they
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  I think it was exciting then, but it's
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  even more exciting now.
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  Yeah. A 100%. We're always we're always waiting
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  for that new that new shiny object. It's
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  always about to come, and and we do
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  get it. And then there's another one.
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  What
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  opportunities and headwinds do you have your eye
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  on right now in health care?
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  Yeah. You know, I mean, I think definitely
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  the the you know, from my position in
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  the emergency department, one of the biggest headwinds
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  is this kind of national crisis we're having
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  around boarding and capacity.
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  We experienced it at Stanford, but we're not
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  the only ones. I mean, emergency departments that
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  are half filled, sometimes
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  three quarters filled with,
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  you know, overflow
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  boarding patients,
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  who are, you know, admitted at the hospital.
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  And, you know, the
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  the associated problem of just inpatient hospitals not
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  having enough space,
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  you know, either either because they lack the
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  the physical
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  plant to do it or because they don't
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  have sufficient staffing to utilize their beds.
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  You know, I I think the other thing
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  that we're grappling with at Stanford, and I
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  know we're not the only ones, is, you
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  know, the acuity,
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  that we see is rising.
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  Some of that is due probably to an
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  aging population.
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  Some of it is, you know, a little
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  bit of a mystery. It'd be interesting to
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  see, you know, from a population health perspective
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  when we look back on this era post
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  COVID and study it, you know, why acuity
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  seems to be rising in EDs across the
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  country. But it it it's definitely true for
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  us, and I know it's true for others.
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  So how do you deal with that? More
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  people coming in the door,
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  those people are sicker than they've ever been,
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  and you have to manage that with fewer
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  beds than you've, you know, than you're used
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  to having to care for that population.
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  Yeah. And and you mentioned, you know, kinda
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  needing more staff
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  influx of patients.
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  So, you know, a lot of times that's
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  acquired through growth, obviously. So how are you
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  thinking about growth and adding value to your
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  your organization?
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  Yeah. It's interesting. You know, in the emergency
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  department, we're one of the only,
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  you know, clinical groups that really doesn't wanna
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  grow too much. I think I think we
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  would prefer if there were fewer patients coming
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  in the door or at least if the
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  patient's coming in the door,
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  you know, we're, we're ones who,
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  you know, truly needed our care. You know?
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  Unfortunately, obviously, all of the growth that we
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  experience is due to other downstream challenges in
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  our health care system and and patients not
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  being able to access the right care in
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  the right place at the right time.
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  And so, you know, for us, it's
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  it's less about how do we get more
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  patients in the door. But, you know, given
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  that there are more patients coming in the
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  door, how do we grow our functional capacity
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  to care for them?
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  Because, again, without without being able to usually
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  grow our physical spaces,
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  it's it's about how can you see more
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  people with the same resources. And so a
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  lot of times that is,
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  you know, just traditional
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  operational efficiency. You know, how do you triage
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  more efficiently? How do you, move patients through
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  the the standard phases of care, get their
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  labs quicker, their imaging quicker, their consultations quicker
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  so that they can get dispositioned and you
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  can make more space for the next patient.
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  Sometimes it is, you know, utilizing technology
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  to develop,
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  you know, novel treatment pathways. At Stanford,
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  we have a virtual visit track. So patients
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  who show up to our ED,
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  if they meet criteria,
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  can get, funneled over to a,
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  a telemedicine
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  track where they sit in front of a
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  computer, and they're seen virtually by a remote
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  emergency physician who can still give them all
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  the care that they need, and and those
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  patients get through a lot more quickly and
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  get home.
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  And then it's also, you know, how can
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  we think about
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  it's because because the walls of our ED
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  aren't gonna change. How do we expand the
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  care we provide beyond the walls of the
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  ED? How do we,
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  you know, intervene when a patient is considering
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  emergency care
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  and, you know, either either make sure that
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  they come in to get it or make
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  sure that if if they don't need to
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  come in, that they're still getting the care
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  that they need outside of that. So, for
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  example, you know, again, at Stanford, we have
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  set up a program where we've got a
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  telemedicine card at a local skilled nursing facility.
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  And, you know, when they're contemplating bringing appreciation
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  into the ED, they instead put them in
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  front of the cart. And one of our
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  EM docs is able to to very often
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  care for them there on the spot preventing
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  an ED arrival. And so those are kind
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  of some of the ways that we're thinking
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  about how do we,
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  given that our volume are is expanding, how
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  do we expand our ability to provide care
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  for this larger patient population with the same
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  resources?
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  Do you think the virtual visit track has
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  already made a big difference in terms of
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  efficiency?
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  Oh, yeah. I mean, so,
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  and you kinda had to think of efficiency
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  a little bit differently, actually, when you're talking
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  about things like the virtual visit track. So,
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  you know, is is that doc churning through
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  as many patients per hour as they are
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  in some of our other zones? Frankly, no,
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  if you look at the statistics.
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  However,
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  you know, when you got somebody who is
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  seeing sometimes
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  22, 23, 24
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  patients a day, and they're doing it just
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  with a cart. No ED room necessary.
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  That's huge. I mean, that is 10%,
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  of our daily arrivals,
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  and we don't even need a bed.
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  And so it's,
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  definitely resource efficient when you're talking to the
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  when the resource is the geography. It's tremendously
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  efficient on that front. And then it's also
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  very efficient when the when the resource you're
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  talking about is that patient's time. They get
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  through much faster,
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  and they they don't crowd up our our
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  ED waiting room quite so much. And then,
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  you know, actually, it's turned out that,
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  it's very popular from a patient perspective as
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  well. It's
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  surprising to us, but it continues to be
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  our most popular zone in the ED right
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  now. And so,
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  you know, it's it's when it's safe care,
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  the patients like it, and it's very efficient.
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  I mean, it's it's turned out to really
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  hit on all fronts.
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  Sounds like it's popular for good reason there.
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  Let me ask you, what is one risk
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  or investment do you think is worth making
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  this year?
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  Yeah. I mean so I I think there's
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  there's
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  probably a few
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  a few things to think through here, but
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  I I would say
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  this year going into '26,
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  I think
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  it's a very important time for EDs to
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  start integrating things like predictive analytics into their
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  workflows.
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  This is a kind of thing that I
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  think three, four years from now even will
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  be
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  absolutely standard, and emergency departments that have a
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  bit of a jump start on how to
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  utilize them are going to be,
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  you know, ready for the continued increase in
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  in patients coming through our doors.
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  So, you know, we're we're
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  planning to implement in the coming year, for
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  example, predictive analytics at the point of triage
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  to help us
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  determine whether a patient is appropriate for things
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  like our virtual visit track or our vertical
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  work streams, or can they just be discharged
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  from the waiting room, or do they we
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  need to send them to one of our
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  high acuity areas so that we can make
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  sure we're utilizing,
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  you know, our care spaces most appropriately. We're
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  looking at utilizing it, upstream at the hospital
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  capacity level so we can better predict ED
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  inflows, surgical inflows, transfer center inflows.
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  And, therefore,
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  you know, kind of pre pull levers some
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  of our interventions when we anticipate we are
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  going to have heavy capacity days rather than
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  being quite so reactive. And I think by
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  doing that, we'll harvest a lot of efficiency.
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  And then, you know, there's a lot of
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  other opportunities here. I think from, like, a
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  a needy
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  operations and management standpoint
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  using,
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  AI for charting, I think, for us, we
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  we've been doing this already, has produced more
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  thorough charting that is more amenable to being
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  coded appropriately so you can get paid appropriately
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  for the work that you do. And then,
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  you know, I I think once you've got
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  AI that's got access to some of the,
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  you know, ED notes and also the structured
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  data in the chart, there's a lot of
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  additional opportunities,
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  I think, as well.
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  A lot of additional opportunities as well,
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  for us to start predicting things like, you
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  know, which patients might benefit from early palliative
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  care intervention, which patients are likely to need
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  ICU care, and therefore we can, you know,
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  move them up there more quickly and also,
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  you know, convey that information to the, you
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  know, the hospital
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  capacity leads.
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  Or, you know, even which patients are likely
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  to have a bad experience where while they're
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  there. So we can utilize kind of our
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  our,
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  our resources well to, you know, help smooth
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  some of that over and, you know, make
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  sure that all of our patients are getting
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  the care that they need with, you know,
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  in in the manner that that meets their
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  needs. So I think there's a a lot
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  a lot of opportunities
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  that,
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  it's worth dipping our toes into,
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  if not jumping in with both feet in
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  '26.
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  Because I think these trends of increasing volumes,
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  increasing acuity are not really going to stop.
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  And so these are the types of tools
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  we gotta get facility with quickly so that
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  we can not be overwhelmed in '27 or
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  '28.
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  And the last question I have for you,
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  doctor Rivera, where do you see the best
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  opportunities
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  for growth in the future?
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  So
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  I think I think we've talked about one,
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  which is
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  predictive analytics,
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  AI enabled,
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  care and operations within the walls of the
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  ED.
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  You know, I I do think another area
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  again, growth is interesting concept in the emergency
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  department. So another interesting
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  another way that we can think about how
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  to extend our capabilities
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  is through this idea of expanding emergency medicine
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  beyond the walls of the ED. And we
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  talked about a a few of those ways
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  that that can be done, I think, through
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  telemedicine,
• 11:50
  you know, telesniff programs, tele EMS programs, which
• 11:52
  are very analogous.
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  On the other end of the spectrum,
• 11:56
  hospital at home programs, and that's something also
• 11:58
  that we're looking at at Stanford is, you
• 12:00
  know, discharging people from the hospital a little
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  bit earlier than we otherwise would.
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  But we do that because we have a
• 12:06
  remote provider who can check-in on them and
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  get them the last, you know, vestiges of
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  what they would have gotten inpatient. And we're
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  looking at doing that from the ED as
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  well so that we can take patients we
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  might have admitted to a physical, you know,
• 12:18
  clinical decision unit or an ops unit and
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  instead do ops at home.
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  I think those those are some big opportunities,
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  that and we have the technology to do
• 12:27
  now. It's just about the workflows. And then
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  on the other end, you know, the spectrum,
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  I think
• 12:33
  there's in addition to things like telesniff and,
• 12:36
  tele EMS control,
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  there are, I think, a lot more opportunities
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  through digital health and telemedicine to provide patients
• 12:44
  with tools and education in real time as
• 12:47
  they're contemplating ED care,
• 12:49
  that can,
• 12:50
  you know, prevent visits,
• 12:52
  that are unnecessary
• 12:54
  and get patients a little bit better targeted.
• 12:56
  So I I think, there
• 12:58
  I know at Stanford,
• 12:59
  a lot of our outpatient
• 13:01
  clinics have now converted to telemedicine, and many
• 13:03
  of those in conjunction with, like, remote patient
• 13:05
  monitoring tools,
• 13:07
  are able to identify patients who,
• 13:10
  are,
• 13:11
  you know, having chronic issues with their chronic
• 13:14
  diseases
• 13:14
  escalating or, you know, other concerns that might
• 13:17
  eventually lead to an emergency presentation, and they're
• 13:19
  able to intervene remotely,
• 13:22
  before that happens. And so I think those
• 13:23
  are
• 13:25
  again, it's not about expanding
• 13:27
  space. Of course, if your an ED has
• 13:28
  the opportunity to expand your your care spaces,
• 13:31
  you should probably take it. You're probably gonna
• 13:33
  need it. But most of us don't have
• 13:34
  that, and so it is,
• 13:36
  extending our ability to care for patients into
• 13:39
  the pre and post ED visit space,
• 13:42
  to make sure that they're getting the right
• 13:44
  care in the right place at the right
• 13:45
  time and making sure that the precious ED
• 13:48
  space that we have is utilized for those
• 13:51
  who need it most.
• 13:53
  Doctor Roberta, thanks so much for joining us
• 13:55
  on the podcast. It was a great conversation.
• 13:57
  I look forward to working with you again
• 13:58
  soon. Yeah. Thanks so much for having me.