Latest / Becker’s Healthcare Podcast / Chirag Choudhary, MD, MBA, Vice President and Chief Medical Officer for Cleveland Clinic Martin Health, and Marc Babi, MD, MBA, FNCS, Professor of Neurology at Cleveland Clinic and Case Western University, Florida Region, and Center Director for Neur

Transcript

Chirag Choudhary, MD, MBA, Vice President and Chief Medical Officer for Cleveland Clinic Martin Health, and Marc Babi, MD, MBA, FNCS, Professor of Neurology at Cleveland Clinic and Case Western University, Florida Region, and Center Director for Neur · Becker’s Healthcare Podcast

• 0:02
  - There's a small circle of people who truly
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  - workforce strategy, and the leadership questions that don't
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - This is Laura Dirdo with the Becker's Healthcare
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  - podcast. I'm thrilled today to be joined by
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  - doctor Chiturag Choudhury,
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  - vice president and chief medical officer for Cleveland
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  - Clinic Martin Health, and Doctor. Mark Bobby,
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  - the Cerebral Vascular Center director of Cleveland Clinic
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  - Florida, as well as professor of neurology at
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  - Cleveland Clinic Case Western University.
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  - Doctor Choudhury, doctor Bobby, thank you so much
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  - for joining us on the podcast today.
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  - Thank you.
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  - Thank you.
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  - Fantastic. Well, I'm excited for our conversation. I
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  - know we're gonna talk a lot about,
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  - everything you're doing at Cleveland Clinic or... Think
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  - about stroke care and some of the big
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  - trends that are happening there, as well as
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  - how you're looking at the future. But before
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  - we dig in, I would love to have
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  - you both just tell us a little bit
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  - more about yourselves and your role at Cleveland
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  - Clinic. So, doctor Chowdhury, we'll start with you.
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  - Yeah. Thank you. Laura, thank you for having
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  - this conversation. And by me,
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  - my name is Chirag Chowdhury.
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  - Pulmonary critical care by training, and I serve
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  - as the vice president and chief medical officer
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  - for Cleveland Clinic Martin Health.
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  - Cleveland Clinic Martin Health is part of our
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  - five hospital
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  - system that we have here in Cleveland Clinic
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  - Florida.
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  - And Cleveland Clinic Martin Health itself is... Includes
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  - Cleveland Clinic Martin North,
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  - Martin South, and Cleveland Clinic Tradition
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  - in addition to our ambulatory sites and surgical
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  - centers.
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  - So proud to be a part of this
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  - organization and to partner with Mark, with all
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  - the growth that we've had in neurology.
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  - And doctor Bobby? Yeah. Thank you. Thank you,
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  - Laura, for having me. My name is Mark
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  - Bobby. I'm a professor of neurology at Cleveland
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  - Clinic
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  - Case Western Reserve, and I serve also as
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  - a cerebrovascular
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  - center director for Cleveland Clinic Florida. Meaning, within
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  - the cerebrovascular
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  - center, I oversee stroke, neurohospitalist,
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  - cerebrovascular neurosurgery, and neurointervention
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  - within our five hospital system in Florida,
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  - which include two comprehensive stroke centers, Cleveland Clinic
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  - Western Hospital and Cleveland Clinic Tradition Hospital, which
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  - is also a joint commission certified,
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  - stroke center, as well as a thrombectomy stroke
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  - center at Cleveland Clinic Indian River and a
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  - primary stroke center at Cleveland Clinic Martin North
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  - and South.
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  - By training on clinical practice, I'm a neurologist
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  - and neurointensivist.
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  - So I see patients
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  - admitted in the hospital,
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  - both in the ICU and non ICU, and
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  - I care for the whole spectrum of acute
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  - neurological
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  - emergency in the hospital. Patient with traumatic brain
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  - injury,
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  - stroke,
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  - critically ill, postoperative,
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  - patient admitted in the hospital.
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  - A large part of my role
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  - is building the system of care around the
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  - whole spectrum of acute neurological care. So together,
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  - bring in, emergency medicine,
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  - neurologists, neurointerventionalists,
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  - neurosurgeon,
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  - intensivist, nursing imaging, EMS
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  - for the whole purpose of this three sixty
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  - care of our critically ill neurological and neurosurgical
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  - patients.
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  - That's amazing to hear. You know, it's really
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  - cool to understand your background and all the
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  - accomplishments that you've had at Cleveland Clinic, and
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  - I know we'll dig into a couple more
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  - here. So first and foremost, stroke care has
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  - evolved significantly over the past decade.
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  - Where do you see some of the biggest
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  - gaps that still exist notch... Nationally
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  - in how hospitals identify, triage, and treat stroke
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  - patients. Doctor Bobby, we'll start with you. No.
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  - Thank you. I think one of the key
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  - fundamental
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  - principle in stroke care, again, both ischemic and
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  - hemorrhagic,
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  - stroke care, is that time is brain.
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  - We know over the last decade,
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  - we've had extraordinary treatment and advance in the
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  - management of both hemorrhagic and ischemic stroke.
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  - However, this treatment are only effective really when
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  - we... When they reach the right patients through
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  - the right system
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  - and into the right time window.
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  - What we're saying stroke is that there is
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  - a golden window for how we're effectively
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  - able to, treat stroke and potentially salvage and
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  - recover the damage,
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  - that can occur from stroke. So the key
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  - major gap that remains both recognition and triage.
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  - Often, stroke symptom can be ambiguous or even
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  - missing the community. So
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  - the care of stroke patients start in the
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  - field, stronger partner with EMS
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  - and the community,
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  - recognizing stroke symptom and then bringing the right
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  - patient to the right system of care
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  - because not every hospital is equipped to treat
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  - every stroke patient. And that has to do
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  - with the level of care that hospital provide
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  - to stroke. There are three
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  - vastly different,
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  - level of care in raising complexity from a
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  - primary stroke center, which are hospital that can
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  - basically triage and stabilize,
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  - initial stroke symptom, however, not equipped
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  - to provide more advanced, stroke care.
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  - Then second level of complexity is what we
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  - call thrombectomy center. That's our hospital that have
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  - specialists,
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  - equipment,
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  - and system of care that can provide some
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  - more advanced ischemic stroke management. And then the
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  - more complex
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  - level of care is what we call a
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  - comprehensive stroke center.
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  - Just a hospital that have specialists,
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  - equipment,
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  - consultant that can provide a more complex advanced
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  - management of both ischemic and hemorrhagic,
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  - stroke care.
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  - Another
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  - important gap is what happened to the patient
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  - after they've been treated and stabilized in the
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  - hospital, but their follow-up,
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  - and post stroke care, meaning rehabilitation,
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  - neurology follow-up, recovery,
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  - and longitudinal
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  - follow-up. There is
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  - major disparity in access to health care, and
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  - we know social determinant of health play a
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  - major role.
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  - Hence, that is a really an important,
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  - facet of how we prevent readmission and then
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  - second redeterioration for a lot of those stroke
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  - patients.
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  - That's helpful to understand. And, definitely, it makes
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  - a big difference when you are identifying and
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  - seeing some of those gaps, and and then
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  - you can figure out what needs to happen
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  - in order to expand that access and and,
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  - bring patients in. Doctor Choudhary, what are your
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  - thoughts? How are you seeing,
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  - stroke patients continue to think through and access
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  - care?
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  - Yeah. My
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  - role is to be
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  - able to support our neurological
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  - institute
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  - and and doctor Babbid so that we can
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  - provide these services in our community.
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  - Cleveland Clinic Martin Health encompasses both Martin County
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  - and St. Lucie County.
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  - And, it's tradition that is a joint commission
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  - certified comprehensive
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  - stroke center.
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  - So
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  - what we have to provide as a team
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  - is it doesn't really matter as to which
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  - one of our hospitals this patient shows up
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  - at. It doesn't matter if it's one of
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  - our freestanding EDs that the patient shows up
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  - at, that the time to recognition, time to
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  - treatment
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  - that that we are able to provide that
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  - same standard of care
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  - across the board.
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  - So that's really has been an imperative for
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  - us is provide, you know, timely care, body
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  - recognitions,
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  - the same standard of care irrespective of whatever
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  - the patient shows up.
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  - And also what allows us to really leverage
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  - our strengths is as
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  - part of a much larger Cleveland Clinic organization,
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  - have the telehealth availability
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  - from our neurological institute colleagues, in, Ohio.
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  - Would we be able to provide that 247,
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  - 365
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  - coverage? That's that's what really...
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  - That is what I think separates us from
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  - a lot of the a lot of the
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  - other organizations is to be able to truly
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  - provide a world class carrier to Florida.
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  - And that makes a lot of sense. And,
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  - you know, it is, really incredible to have
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  - that type of goal and then be able
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  - to put the resources behind it and the
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  - energy and and drive and desire to keep
• 8:24
  - improving and provide those great hospitals and standardized
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  - experience across the board, and across the health
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  - system.
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  - Now I know Cleveland Clinic Tradition Hospital recently
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  - earned a joint commissions
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  - advanced comprehensive
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  - stroke center designation.
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  - This is the first in Florida's Treasure Coast
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  - to do so. What does that actually take
• 8:44
  - operationally to reach that level of certification?
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  - Absolutely. So comprehensive
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  - stroke center designation, advanced comprehensive,
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  - designation is the highest level
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  - of joint commission recognition and accreditation
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  - for,
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  - the system of care
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  - and the stroke management. But really to do
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  - that, it basically take years
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  - of coordinated multidisciplinary
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  - work across the entire health care system, meaning
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  - you have vascular neurologists, neurointerventionalists,
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  - neurosurgeon,
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  - intensivists,
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  - emergency physician, radiologists,
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  - specialized nurse, rehabilitation
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  - team, and most importantly,
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  - administration support
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  - of building that whole integrated model of care
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  - of stroke. So you need the infrastructure. Basically,
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  - you're offering a twenty four seven access to
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  - the most advanced stroke managements,
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  - and the sickest neurological patients.
• 9:35
  - It also take a biplane suite and advanced,
• 9:38
  - OR, for very specialized cerebrovascular
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  - surgery
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  - and,
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  - a a community model and and referral system
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  - from surrounding hospitals, freestanding ED, etcetera, that that
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  - bring,
• 9:50
  - patient with acute neurological emergency and a hub
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  - and spoke model of care. So it's not
• 9:55
  - just a technology or specialist, but it's the
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  - whole three sixty,
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  - standardized approach for the care of those stroke
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  - patient.
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  - It also takes, of course, standardized protocol, continuous
• 10:04
  - quality measurements, and and education
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  - to its ever changing advances stroke care. For
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  - example, very recently, there are some very specific
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  - technique on how we manage certain aspect of
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  - strokes and with specific protocol and standardization,
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  - and, importantly, multidisciplinary case review as we undergo
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  - through.
• 10:21
  - Continuous improvements, and we,
• 10:24
  - reevaluate
• 10:25
  - and reevaluate every stroke management case learning from
• 10:28
  - what we can even do better and serving,
• 10:30
  - the community.
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  - All of that coupled with sustained institutional support
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  - in building a sustaining and comprehensive,
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  - stroke center. So basically, in summary, the designation
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  - of a comprehensive stroke center is not just
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  - a finish line but it's a recognition for
• 10:43
  - the care and a validation of the system
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  - that we've built being capable of delivering the
• 10:48
  - most advanced and complex stroke care consistently.
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  - All of that coupled in collaboration with entire
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  - enterprise, we're very proud of recognizing that in
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  - Florida but also within Florida operating as one
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  - system,
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  - as a fully integrated Cleveland Clinic Florida model
• 11:02
  - of care while continuously collaborating and working as
• 11:03
  - an
• 11:06
  - colleague and leadership in Ohio, both in clinical
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  - integration
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  - and also continuous improvement and, administrative
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  - review of our stroke programs.
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  - That's,
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  - really impressive, and and thank you so much
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  - for digging into,
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  - how you're really able to achieve this accomplishment.
• 11:29
  - I think, it's easier said than done in
• 11:31
  - many ways to,
• 11:33
  - really align around the principles that are gonna
• 11:35
  - get you there and then have the implementations,
• 11:37
  - have the right mindset, and everybody working together,
• 11:41
  - to to achieve the type of program that
• 11:43
  - you're looking for.
• 11:45
  - And, Laura, I'll definitely like to add, you
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  - know, these are
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  - recognition and accreditations
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  - that we don't need to have.
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  - We choose to have.
• 11:57
  - It's really a testament to Mark and the
• 11:59
  - Neurological Institute team that they have continued to
• 12:02
  - push the envelope to continue to try and
• 12:04
  - improve the care that we can provide in
• 12:06
  - the community.
• 12:07
  - Because this is in our DNA, we're, like,
• 12:09
  - gonna constantly be striving to striving to improve.
• 12:13
  - So the fact that it's timely care, it's
• 12:17
  - standardized care, we have a report card that
• 12:19
  - we share with the accreditation body... Bodies to
• 12:22
  - to make sure that we are actually doing
• 12:24
  - what we're doing,
• 12:26
  - helps build... Helps build a lot of trust
• 12:27
  - in the community.
• 12:30
  - And that trust is so important and and
• 12:32
  - critical, now more than ever. It it seems,
• 12:35
  - you know, to make sure that, people can
• 12:37
  - access the care that they want and then
• 12:39
  - truly trust in the clinicians that are delivering
• 12:42
  - it. So, that's really cool to hear.
• 12:45
  - Now, doctor Bevy, I know your background is
• 12:48
  - in pulmonary critical care, and and you've spent
• 12:50
  - a lot of your career standardizing some of
• 12:52
  - the care protocols across the health system. So
• 12:54
  - how does that experience shape the way that
• 12:56
  - you approach building high performing stroke programs across
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  - the hospitals?
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  - Yep. So my background is actually in neurology
• 13:03
  - and neurocritical
• 13:04
  - care because I do a lot of, intensive
• 13:06
  - care, particularly in patient with with with acute
• 13:08
  - neurological and neurosurgical emergency. But really that critical
• 13:11
  - care experience
• 13:13
  - has a major influence on high approach system
• 13:15
  - of care and especially stroke system. So neuro
• 13:18
  - intensive unit and critical care unit,
• 13:21
  - I know that really excellent outcome is not
• 13:23
  - only dependent on individual expertise, which is really
• 13:26
  - important, but really how the entire system performed,
• 13:29
  - that multidisciplinary approach and the multi systematic
• 13:32
  - approach.
• 13:33
  - I draw very parallel in how I applied
• 13:35
  - in a stroke program and the model of
• 13:37
  - care for stroke, especially across
• 13:39
  - multiple hospital.
• 13:41
  - And importantly with division on the goal of
• 13:43
  - reducing
• 13:44
  - unnecessary
• 13:45
  - variation.
• 13:46
  - If one patient presents at one hospital, especially
• 13:49
  - within our community,
• 13:51
  - they benefit from the same expertise that is
• 13:53
  - is present, not just within our system, but
• 13:55
  - within the entire Cleveland Clinic enterprise. And that's
• 13:58
  - the leverage of how we use being an
• 14:00
  - integrated
• 14:01
  - clinical enterprise that really distinguish us from the
• 14:03
  - other comprehensive stroke system and the other neurological
• 14:06
  - systems throughout the country. We'll leverage that expertise
• 14:09
  - not just within The United States, but as
• 14:11
  - a as a global enterprise. We have multidisciplinary
• 14:14
  - conference, multidisciplinary case review, where we bring expert
• 14:17
  - within our Cleveland Clinic health care system worldwide.
• 14:20
  - We can have a super specialized,
• 14:22
  - neurosurgeon
• 14:24
  - across the the continent in Cleveland Clinic, Abu
• 14:26
  - Dhabi or London or vice versa, where we
• 14:29
  - share best practices, we share some idea, forum,
• 14:31
  - and and, that really, again, distinguish us.
• 14:35
  - And at the same time, of course, every
• 14:36
  - hospital
• 14:37
  - may have different local constraint, different resources, different
• 14:41
  - capabilities. So the goal is not to make
• 14:43
  - every hospital
• 14:44
  - identical
• 14:45
  - but really through that integrated
• 14:47
  - network and leveraging on our healthcare model, each
• 14:50
  - hospital understand its role, understand its capability, and
• 14:54
  - then patient can move seamlessly within the appropriate
• 14:56
  - level of care and delivering the best care
• 14:59
  - for the best patient. How do we achieve
• 15:01
  - that operationally? We have shared protocol, best practices,
• 15:04
  - common quality metric,
• 15:06
  - strong communication dialogue,
• 15:08
  - multidisciplinary
• 15:09
  - collaboration on clear transfer protocol.
• 15:13
  - And that's really helpful. And, you know, I'm,
• 15:16
  - curious from
• 15:18
  - both of you, you know, when you are
• 15:20
  - are doing this, when you're bringing in some
• 15:21
  - of the protocols or developing the protocols and
• 15:24
  - then standardizing across the board,
• 15:27
  - what is the process like? I know... I
• 15:29
  - can imagine a lot of,
• 15:31
  - physicians and and clinicians,
• 15:33
  - have their own way of doing things. And
• 15:35
  - so how do you make sure you're developing
• 15:36
  - something that, you know, will,
• 15:39
  - make sense and then be implemented and and
• 15:41
  - really feel like it's,
• 15:43
  - gonna do the best job possible for patients,
• 15:46
  - in the physicians involved.
• 15:53
  - Mark, I'll take a stab at it, and
• 15:54
  - then I'll I'll let you I'll let you
• 15:56
  - add.
• 15:56
  - Yeah. I think this...
• 15:59
  - Going going back to the team that we've
• 16:01
  - been talking about is
• 16:03
  - being part of a much larger organization.
• 16:07
  - We have done this in in Ohio.
• 16:11
  - We can learn.
• 16:12
  - We have the protocols in place. We know
• 16:15
  - that when we have,
• 16:18
  - a system that works, that patients get timely
• 16:21
  - care, that patients get... Have great outcomes.
• 16:24
  - And when you when you have that kind
• 16:26
  - of, you know, you have both
• 16:28
  - the the time that you've invested in developing
• 16:30
  - these protocols, you have results that are verified
• 16:33
  - verifiable.
• 16:34
  - Those become hard to argue against.
• 16:37
  - And that's that's that's when you can that's
• 16:40
  - when you can get the buy in that,
• 16:41
  - you know, if you do the right things,
• 16:42
  - you get the right outcome and
• 16:45
  - it's just a much, much easier conversation
• 16:47
  - to have.
• 16:48
  - The next, you know, as Mark talked about
• 16:50
  - is meeting
• 16:52
  - every hospital where they're at and to be
• 16:54
  - able to kind of
• 16:56
  - do the best possible with the resources that
• 16:59
  - are available.
• 17:00
  - And that's why we've chosen
• 17:03
  - within our hospital system, we have different centers
• 17:06
  - of excellence for different institutes.
• 17:09
  - And neurological institute is focused at traditional hospital
• 17:11
  - to be able to provide this expert level
• 17:14
  - of care for our health system.
• 17:16
  - So we're not, we want to be able
• 17:18
  - to diffuse the care across multiple counties and
• 17:21
  - and and communities,
• 17:22
  - We wanna be able to concentrate the expertise
• 17:25
  - so that we have all these like a
• 17:27
  - players working working with other a players be
• 17:29
  - able to provide this,
• 17:30
  - incredible, incredible service.
• 17:33
  - No. Thank you, Doctor. Chaudhary, and very eloquently,
• 17:36
  - say it. I mean, really to echo that
• 17:37
  - it's about designing
• 17:39
  - a system,
• 17:41
  - both a coordination response system,
• 17:45
  - that really holds up under pressure and deliver
• 17:47
  - consistently,
• 17:49
  - creating
• 17:49
  - a standardized,
• 17:51
  - measurable,
• 17:52
  - and actionable,
• 17:53
  - system to put it at a concrete,
• 17:56
  - clinical care path.
• 17:58
  - If we have a stroke, in the community,
• 18:01
  - patient and the community EMS recognize that,
• 18:04
  - activate level of care, bring the patients, to
• 18:08
  - our hospital or one of our facility where
• 18:10
  - a whole system is mobilized
• 18:12
  - and activated in parallel rather than, sequentially.
• 18:16
  - But then the care and the system doesn't
• 18:18
  - end there. That is just the beginning where
• 18:19
  - we're now continuously measuring,
• 18:23
  - our system and efficiency. There are some very
• 18:25
  - specific stroke related and neurological metric
• 18:28
  - that we analyze. We try to identify, are
• 18:31
  - there any gap within system or pathway or
• 18:33
  - bottlenecks? Are there any unexpected or expected complication
• 18:37
  - outcome? And where do individual case are within
• 18:40
  - that process that worked or did not work
• 18:42
  - as,
• 18:43
  - intended.
• 18:44
  - And that come with what we call the
• 18:45
  - high reliability measure that come from that, where
• 18:48
  - we create a fail proof system that is
• 18:51
  - not just hinging on one, specific tenant of
• 18:54
  - that entire, system of care. But the end
• 18:56
  - result is that,
• 18:58
  - we design system that are high performing. The
• 19:00
  - metric reflect the quality of care, and most
• 19:02
  - importantly, it's giving it back to the community.
• 19:05
  - And to share that concretely,
• 19:07
  - our hospital in Florida have been among the
• 19:10
  - highest performing within the entire enterprise, but tradition
• 19:12
  - specifically is among the top performing
• 19:15
  - hospital within our entire Cleveland Clinic enterprise where
• 19:18
  - it's come to the entire cerebrovascular
• 19:20
  - care of those sickest of those patients.
• 19:25
  - Absolutely. Wow. That... That's really cool to hear.
• 19:28
  - And, definitely,
• 19:29
  - you know,
• 19:30
  - it's helpful to understand how you've done it
• 19:32
  - because I know so many of our listeners
• 19:33
  - are trying to figure out,
• 19:35
  - what the right process and and steps and
• 19:37
  - and way to organize
• 19:39
  - a leadership,
• 19:40
  - on down to achieve some of the similar,
• 19:43
  - similar things that you're doing at Cleveland Clinic.
• 19:45
  - So it's great to hear.
• 19:47
  - And I know every moment counts, and it
• 19:50
  - is important to be able to do that.
• 19:52
  - So,
• 19:53
  - I think before we wrap up here, I
• 19:54
  - wanted to look into the future too. Where
• 19:56
  - do you see some of the next frontier
• 19:58
  - of stroke care headed? What's next for the
• 20:01
  - the industry as well as for Cleveland Clinic
• 20:04
  - itself?
• 20:06
  - Go ahead, Mark. Sure. Absolutely.
• 20:09
  - I mean, stroke is really evolving, and it's
• 20:12
  - incredible
• 20:13
  - how much the the treatment, the diagnosis, prognosis
• 20:16
  - have changed in the last, twenty years. I
• 20:18
  - really want a big area right now is,
• 20:21
  - the area of artificial intelligence and advanced,
• 20:24
  - imaging analytics.
• 20:26
  - That has become increasingly more helpful as an
• 20:29
  - adjunct tool that help clinician identify early stroke
• 20:32
  - symptom,
• 20:33
  - meaning, instead of waiting for the human factor
• 20:36
  - to interpret imaging, we have now adjunct,
• 20:39
  - AI that will actually calculate the area of
• 20:41
  - stroke or the volume of brain bleed or
• 20:43
  - even hint a clinician to look at specific
• 20:46
  - area of the brain, like, pay attention to
• 20:47
  - that area. There may be an area of
• 20:49
  - abnormality or an aneurysm or other abnormality.
• 20:52
  - So it's not really replacing the clinician in
• 20:55
  - complex decision making, but it helped as an
• 20:57
  - ad... Or it it serve as an adjunct
• 20:59
  - tool that really improved both efficiency
• 21:01
  - and improved throughput and improved, diagnostic,
• 21:05
  - accuracy.
• 21:06
  - So that's been really excited
• 21:08
  - and also some really advanced in minimally invasive
• 21:11
  - brain surgery.
• 21:12
  - Historically, for some of the more complex,
• 21:15
  - abnormal vascular of the brain or vascular malformation,
• 21:18
  - those who acquired very complex open type of,
• 21:20
  - cranial surgery.
• 21:22
  - Now with advanced,
• 21:24
  - both AI tool and advanced imaging tool,
• 21:27
  - a surgeon are able to do minimally invasive
• 21:30
  - brain surgery for same very complex vascular malformation
• 21:34
  - either through eyelid surgery or catheter based,
• 21:37
  - endovascular
• 21:38
  - surgeries
• 21:39
  - for the same pathology that just a couple
• 21:41
  - of years ago were either inoperable
• 21:44
  - or very difficult to operate with very protracted
• 21:47
  - recovery.
• 21:48
  - Now it's literally
• 21:50
  - either a one day ICU stay or even
• 21:51
  - non ICU stay, like a step down unit,
• 21:53
  - intermediate care for some very complex brain surgery.
• 21:56
  - So that's been really exciting.
• 21:57
  - And then on the acute ischemic stroke management,
• 22:00
  - there's an evolving landscape of how we treat
• 22:03
  - stroke with
• 22:05
  - IV stromolytics or blood thinner therapy that's also
• 22:08
  - evolving.
• 22:09
  - And also the post stroke recovery with special
• 22:11
  - device that also help patient recover when they
• 22:13
  - have paralysis
• 22:14
  - through certain nerve stimulator. So again, there is
• 22:17
  - a whole advance in the whole continuum of
• 22:19
  - care, and that's been really exciting. And that's
• 22:21
  - gonna be really the future of Sprook.
• 22:25
  - That's fascinating to hear. I I love how
• 22:27
  - you are using
• 22:29
  - AI, using technology to really identify those issues
• 22:33
  - early. And then on the preventative side too,
• 22:36
  - seems like a really great opportunity,
• 22:38
  - to help patients and and everyone,
• 22:41
  - stay healthy and and really ideally not have
• 22:44
  - to,
• 22:45
  - you know, go through more than they need
• 22:47
  - to go through, with the the stroke. So,
• 22:49
  - that... That's great to hear. Doctor Chowdhury, what
• 22:51
  - are your thoughts? What are you seeing?
• 22:54
  - No. I'm gonna
• 22:55
  - probably take a take a broader approach to
• 22:57
  - this.
• 23:00
  - And the the work that we do is
• 23:03
  - is truly life changing.
• 23:05
  - You know, we are in a very sacred
• 23:06
  - profession
• 23:08
  - of taking care of people's lives.
• 23:11
  - And how do we do that better every
• 23:14
  - day? How do we do that across
• 23:16
  - multiple specialties, neurology included, stroke care included?
• 23:20
  - And it really hinges on on a few
• 23:23
  - things, improving access,
• 23:26
  - maintaining
• 23:27
  - quality, patient safety and exceptional patient experience.
• 23:31
  - And then always having this people first approach
• 23:34
  - not
• 23:35
  - just for our patients but also for our
• 23:37
  - caregivers.
• 23:38
  - Where we are recruiting the best, being able
• 23:40
  - to retain them so that we can continue
• 23:42
  - to perform at a high level day after
• 23:45
  - day, week after week, month after month, year
• 23:47
  - after year.
• 23:49
  - And how are we gonna go about doing
• 23:51
  - that? When it comes to access, I feel
• 23:54
  - it's a dual approach. It is both physical
• 23:57
  - and technological.
• 23:59
  - We want to be able to interact with
• 24:01
  - the patient virtually. We also want to be
• 24:03
  - able to create physical spaces so that when
• 24:06
  - that need arises that they're able to
• 24:08
  - connect with us and receive the care that
• 24:11
  - they
• 24:12
  - need at that time.
• 24:14
  - Next is recruitment and retention.
• 24:16
  - And that is where, Mark and I didn't
• 24:19
  - rehearse this earlier but AI is huge. It's
• 24:22
  - gonna be,
• 24:23
  - I think it's gonna be augmentative.
• 24:26
  - It's helping us with recruitment, it's helping us
• 24:28
  - with the retention.
• 24:29
  - It is taking care of some of the
• 24:31
  - mundane activities that
• 24:33
  - we can,
• 24:34
  - you know, have technology handle and allow the
• 24:37
  - people to interact with patients and with people
• 24:40
  - so that they have the joy
• 24:43
  - in medicine that they signed up for.
• 24:46
  - And that we're already starting
• 24:49
  - to see that.
• 24:51
  - So, you know, embracing technology,
• 24:53
  - allowing it to be
• 24:55
  - a deflationary
• 24:56
  - force as we always know, reimbursements continue to
• 24:59
  - go down. So how do you control expenses?
• 25:00
  - You control expenses by leveraging technology.
• 25:03
  - And it's also gonna allow us to democratize
• 25:07
  - this access
• 25:09
  - to
• 25:10
  - truly
• 25:11
  - world class Cleveland Clinic care.
• 25:14
  - And allowing us to spread that across more
• 25:17
  - communities in Florida and and and and and
• 25:20
  - beyond. So that is that is what is
• 25:22
  - the exciting
• 25:23
  - part of being in healthcare right now. You
• 25:25
  - know, we always hear about all the negative
• 25:27
  - news.
• 25:28
  - But I don't... I, you know, personally, I...
• 25:30
  - I'm I'm an eternal optimist. We... There's no
• 25:34
  - more... I think this is, like, this is
• 25:36
  - the most exciting time to be in health
• 25:38
  - care.
• 25:39
  - This in...
• 25:41
  - This collaboration with technology and the clinical expertise
• 25:44
  - that we have, the the the future is
• 25:46
  - very bright. Future is truly very, very bright.
• 25:51
  - Fantastic.
• 25:51
  - I I love that. Doctor Chaudhary, doctor Bobby,
• 25:53
  - thank you so much for joining us on
• 25:55
  - the podcast today. This has been a great
• 25:57
  - conversation, and I really appreciate your time. I'll
• 25:59
  - be excited to catch up with you again
• 26:02
  - soon and keep the conversation going.
• 26:05
  - Thank you, Laura. Thank you very much.