PowerLiving with Kimberlee Langford
PowerLiving with Kimberlee Langford
Innovating Kidney Care: From Telehealth to AI
If you're not following this Nephrologist and Innovative leader in the renal space, you'll be delighted to get to know Dr. Qasim Butt, MD.
In this session, he popped onto a webinar with us at Specialty Care Management to talk about Kidney Disease and innovations in the renal care space, and if you missed our webinar with him last year - here is the podcast version!
Pop some corn and let's dive in!
Thank you, hey, hey, hey, everybody, I hear we have a few people starting to pop on. We're really glad you're here. We're going to get started in a few minutes. I'm really excited Dr Butt's going to be joining us closely or shortly and we're really excited to have Dr Kossum Butt joining our conversation today. I'm a big fan of this nephrologist and since he's not here, we could brag about him for a minute. But Dr Butt carries a lot of experience. He's an interventional nephrologist, astrologist. He's been in practice over 14 years.
Speaker 1:And most recently he's practicing in a university setting, matter of fact today. Oh hey, there he is. I was just bragging about, just to close your ears.
Speaker 2:Oh, is that right.
Speaker 1:Matter of fact, today joins us and he's covering a hospital as we speak, and we're going to talk a little bit about the role of telehealth today as well. So we'll get started here in a few minutes, but feel free to grab some popcorn and your favorite beverage, because we take good care of our kidneys and keep them wet, right, dr Buck?
Speaker 2:I guess so yeah.
Speaker 1:Hey, grab a friend, you might want to take some notes. Every time I have a conversation with Dr Butt or watch one of his webinars, he shares a lot of great content. I always come away smarter, so, yeah, we'll get started here in just a few minutes.
Speaker 2:Thank you.
Speaker 1:Thanks everybody for joining. We're super glad you're here. We're just giving folks a few, just a couple more minutes here to join. We'll be starting here in just a couple of minutes, so welcome. Grab a friend, grab a pen and some notes, your favorite beverage, and we'll get started here in just a minute.
Speaker 2:Sorry, I had to put my glasses on. It makes me look smarter, so I was wanting to make sure oh, does that work I think so. I think my iq points went up by 10, so I'll take every advantage I can I can get.
Speaker 1:You have any of the AI glasses yet. Have you seen those? Oh, are you talking about?
Speaker 2:like they had Google Glass. But they have. Oh you're talking about?
Speaker 1:no, I haven't seen AI glasses, the Tony Stark glasses that I'll read to you yeah, wow, I think those can. I think those will have the capacity to make you 10 percent smarter. Just another minute or so here and we'll get started. I'm giving some folks time to pop on here. Looks like we're just about ready Before we get started. I just wanted to thank everybody for taking some time out to talk about one of my favorite subjects, and here at Specialty Care Management we all like kidneys, but we're really happy to have Dr Kossum Butt here. He's an acclaimed nephrologist, both in the clinical setting and interventional nephrologist, which kind of sounds like a sexy title there Dr Butt.
Speaker 1:You can talk more about that here, but he also has quite a few years extensive in private practice. Currently he's practicing as a partner in a university setting. Currently he's practicing as a partner in a university setting. He's knowledgeable and conversant in the field of value-based care and trends in terms of the market of the industry of kidney care and, if you haven't followed him on LinkedIn or YouTube, he's a passionate educator and he shares a lot of really great content on social media, does some great videos, some of my favorite to watch. He hosts webinars. He lectures on kidney disease and its management and care. He's actively involved also in some really hot innovation in the space, including medical devices, ai, telehealth, remote patient monitoring, which we're going to talk about all of these things digital health, health insurance and more. And he still practices. Matter of fact, he's practicing right now. While he joins us, he's also covering in a hospital in Arkansas. I think that's where you said. You're in two places in Arkansas.
Speaker 2:I think that's where you said you're in two places.
Speaker 1:Talk about duplicating yourself. I think it's really fantastic. We're really on the cusp of some much needed innovation in the space. So, with that, I just wanted to welcome Dr Butt and, before we get, as we get, started, I just wanted to, you know, invite you, dr Butt, to share a little bit about your journey. What brought you this far in terms of your experience so far as a nephrologist?
Speaker 2:Well, I mean, I guess I could start from the beginning, not as a baby, but I'll start at the beginning Once upon a time. Once upon a time I was eight, eight pounds, and you know, I guess I started you know you could say I started practice in 2010.
Speaker 2:I did my training at LSU in Shreveport, louisiana, internal medicine and nephrology a fellowship in nephrology where I actually got interventionally trained. 2010, I moved to San Antonio, joined a practice pretty good practice actually where I got to practice both interventional nephrology and, uh, clinical nephrology, right. So, uh, clinical nephrology is the standard stuff that we all you probably know of dialysis rounds, ckd clinics, hot rounding and hospitals and all that kind of stuff. But interventional is pretty cool because it's actually the way you manage the dialysis access for patients, right. So, um, that was a. I was able to put in catheters for them to have access to their blood for dialysis. I was able to work on dialysis accesses in their arms or fistulas and grafts, was able to put stents in them, declaw them, balloon them, whatever needed to keep them patent and going. So I got to do that for about 11 years, which was super cool Cause I got got to get get to work from the hands. And you start to realize is then, uh, as a clinician, there's certain aspects of care you're better at and there's certain aspects of care you actually like, and so I I like the cerebral nature of nephrologists and those of them called know if you haven't talked to nephrologists, they're uber cerebral, kind of annoyingly cerebral, but like at the same time I'm a guy that likes to work with their hands and fix things and the immediacy of a procedure and fixing things with a procedure was super cool. But I would say, over time what was interesting was like I don't consider it physician burnout, I consider it a bore out. I was bored of doing the same thing over and over again and nephrology itself is such a hasn't had that much innovation.
Speaker 2:To be honest with you, I think most of the innovation in nephrology came in the 1960s and 70s when they invented dialysis and got it out there, and then I think that caused a status quo scenario and that could be from Medicare's payment schemes to nephrologist behavior, to nurses behavior, to patient behavior. But it created a stagnant nature in nephrology for many years, for many decades. Quite honestly, when I started nephrology to where, when I left my full-time practice, I was essentially practicing medicine the same way for about 10, 11 years, where my colleagues in other you know other fields may have had more innovation, more drugs, more different things. Now, in the last few years you've seen some innovation come in, but for the most part it's very stagnant. But in 2021, left my practice kind of left up, brought me, had four months of unemployment, which provides a lot of mental clarity. Had four months of unemployment, which provides a lot of mental clarity. So which was cool I started doing part-time clinical medicine.
Speaker 2:Currently I do part-time clinical medicine at UT Health San Antonio. I do telehealth with Access Telecare, where I cover hospitals in different markets around the country. Currently, right now, I'm covering Arkansas and Virginia. Right now, as we speak, I saw patients earlier this morning and so it's kind of cool. I get to do that from home, which is super cool, but I also consult with technology companies. Those are companies that are in AI, medical device and things like that. So I'm kind of piecemealing different things and trying to figure out what I want to be when I grow up, kind of thing, at this phase of my life.
Speaker 1:Well, I think there's something to that. I think when we find our niche, something, when we find the area for which we really get juiced up about and have a passion for it, it really does lend itself to creativity and innovation and and the drive for excellence. And you know, you mentioned earlier you talked a little bore out versus burnout, where we're in a really interesting phase in the medical space, on the provider and care and side, where people talk about burnout all the time and I don't think people are burnt out. I think we've been beat up.
Speaker 2:So, but I think generally the term is kind of overused to some degree. You know like so. I think it's overused and so there is a component of burnout, right so, but at the same time, is it really burnout or is it just you're bored, like I'm bored?
Speaker 1:you know, I was bored and, yes, I was working hard, don't get me wrong or held back, I mean we are in a situation where, to to a large degree, in a hospital setting, nurses and doctors are pawns and patients, quite honestly, are pawns to get to the dollar and I think a lot of us are kind of I don't want to be used as a pawn. Yeah, I mean.
Speaker 2:I think that's a component too, but I think it's a lot has to do with very several factors. One I generally think about a lot of clinicians and this is what I'm saying as a clinician practicing different in medicine, in a different way now or just part time. Sometimes you need to change the environment and I think, like we get in this mindset as a nurse or a doctor, I got to work for this hospital, I got to work for my practice and I can stay here forever and I'm like sometimes you just need to change your frigging environment. You need to leave that practice, be able to different people, just to get a new energy, a new vibe.
Speaker 1:Also, on top of that, you can practice different medicine meaning like you really found a few things that you're really passionate about and you know where. You talked about a couple of those things already. Where you're, you really kind of have your hand in a lot of things. Can you share a little bit about? Um, uh, you know where you see in terms of from where you have stepped into these other fields. Where are you finding your own personal passion and how is that being received in terms of your peers and in terms of from the nephrology community as a whole?
Speaker 2:Well, I mean.
Speaker 1:I think, it's.
Speaker 2:I think it's kind of multifaceted, to be honest with you. So, like, one of the things that really got me into innovation was my starting to understand, like, the trend of value based care right, and, interestingly enough, I started because I had a social media presence since, like 2017, I was asked to start presenting on this Trump executive order and kidney health the American advancing American kidneys, that America advancing American kidney health act that he signed in 2019. That kind of like like really gave me an in depth financial understanding of the dialysis itself right, and how we need to shift from, like, say, a fee for service model to a more value based model as well, but also the way I always look at value-based care in a weird way.
Speaker 2:I break it down into three things. One is improved clinical protocols. Two is like improved logistical support for doctors and nurses to get things done, whether it be transportation, social work, whatever it is, even dieticians, all that kind of stuff. So logistical support. And three are the payment schemes and the payment models that really go into it Right so, and I think there's different avenues for innovation in all three, you know, and that could be technology that can be better, medication that can be better, clinical protocols that can be with better ways that you know incentivize certain behavior. You know we all monitor, all of us are somewhat monetary driven, and so those kinds of payment schemes can actually improve it.
Speaker 2:As far as the reception from a lot of nephrologists, you know, like I think it depends on the nephrologist. I think I'm not trying to downplay my specialty or my profession, but there's a lot of people that are content with status quo, behavior right, or maintaining the status quo, and that's doctors, nurses and, quite honestly, patients. So the status quo people have a vested interest in status quo. That could be a financial incentive or behavioral incentive, and so there's some people that are looking towards innovation. I always find those people few and far between. It's hard, yeah, it's hard, but it's not just innovation. I'm not saying innovating, but just thinking different. You know what I'm saying, and I think so many people don't want to think different and uh specific, specifically in certain industries that are just dragging along for a while, you know.
Speaker 1:So, yeah, yeah, true, um boy, I have so many awesome uh things to uh asking here. What about um? You know we've talked about this before as well. In terms of a daily, typical nephrology practice, what do you see are the latest medications that CKD folks should be on in order to decrease that? This can be a really hot topic. We were just talking about some of the guidelines around SGLT2s and GLP-1s still a hot topic. You. We were just talking about some of the guidelines around SGLT2s and GLP1s still a hot topic. You and I have talked about some of these meds. What do you see in terms of the nephrologist toolbox are and you mentioned that before there really to date hasn't been a whole lot of innovation in terms of medications to slow down processes, that kind of advancing of kidney disease, but what do you see are some great tools in the medication toolbox.
Speaker 2:Well, I would say, like for decades now, honestly, the staple of care was either ACE inhibitors or ARVs angiotensin receptor blockers. Ace inhibitors typically end with the word PRRL, p-r-r-l, and then lucinopril, placinopril, nalopril, and then you have.
Speaker 2:ARVs, which are angiosensory central blockers endodartan, slow sartan, low sartan and all that. So typically the standard of care was to get the patient on one of those to not only control blood pressure, their blood pressure agents, but also decrease the decline of kidney function, right? So I know most of the people on the call aren't clinicians but kidney disease. You know people on the call are in clinicians but kidney disease. You know, um, kidney disease does typically progress as we get older and depending on your comorbidity, specifically your diet have diabetes that decline can be more rapid than not winding up, you winding up on dialysis and arbs and sorry, sorry sorry, ace inhibitors were both shown to kind of, instead of declining like this to kind of level it off.
Speaker 2:Protect that and that was that was in my arsenal, that's my only. That was like a single shooter. Right, that's my one draw, you know. For the longest time Then, over the last several years I want to say the last five and 10, you've had HDL2s come into the market. Hdl2s are diabetic medications. Right, these are your Frasigika's, your Jardians is. The older agents are like Invokana and all that.
Speaker 2:I'm using the, the trade names, because the generic names I can't pronounce sometimes I'm joking, but those particular agents, they're actually diabetic medications, actually make you pee out a little bit of sugar too. So they help with what we call glycemic control or sugar control, which is awesome. But it also been shown to be renal protected, meaning protecting, protect your kidneys a bit and been shown to be cardio protective. And so initially, when they came out a few years ago, I didn't really start them because I was like this is a diabetic medication, why would I start it? But over the last few years you know the trend in value-based care and just my thought process has changed, and a lot of doctors are doing this now too is they're starting um sglt2s on these patients as well so you know, I that's like a second line of therapy.
Speaker 2:I don't say second line, but it's another line of therapy um, that are there and again. Of course all these medications can't be on everybody. They have to be well tolerated for whatever reasons. But for the most part if I can get at least two agents on these patients, that's an ACE or an ARB or a um or a GLT2 on there.
Speaker 2:And then the latest one is Fineron, which is again I'm using the, the trade name, um, but it's an MRA mineral corticoid receptor agonist, um agonist and or antagonist, excuse me, and it actually um, um, and actually it's been shown to decrease progression as well. So now we actually have three agents that kind of throw on top of that and of course now you have the GLP-1s. Glp-1s are the ozempics and all that, and there's some great data coming out about the GLP-1s specifically. But you know, glp-1s are like your ozempics, your manjaros and all those kinds of medications. But I happen to think you know, if you take an ozempic and you lose 30 pounds, that's a huge burden off the body. You're taking right. So that helps with glycemic control, insulin sensitivity, blood pressure control and to me it causes yeah so to me it winds up being like a you know no crap sherlock kind of scenario.
Speaker 2:You know, I'm saying it's like you just took pounds off a human being.
Speaker 2:of course it's going to have better official effects to the kidneys and there's some evidence now that they're saying it has direct you know, direct effects on the kidney itself. I happen to be in the camp where if you lose 30, 40, 50 pounds, you're you know, you're going to come off some of the blood pressure medications and going to have improved outcomes at the, you know, in various organ systems the kidneys, the heart, the brain, everything else those pleiotropic effects because it protects that intimal lining, the inside lining of the blood vessels.
Speaker 1:really profound the problem we see in the industry. These are hot topics in terms of benefits because they're so expensive. Yeah, and my understanding is that the SGLT2s are probably they're preferred, especially if the gfr the kidney filtration rate is above 30 and they're exquisitely less costly for a plan to cover than the glp1s.
Speaker 2:Absolutely yeah, and also I think as a nephrologist, I wouldn't prescribe a glp1, and the reason being is there's a lot of side effects to those medications you see what I'm saying rapid weight, rapid weight loss and everything.
Speaker 2:To me, that's in the primary care camp. You see what I'm saying. So I'm more about, you know, maximizing medications that I can understand and actually manage the side effects of. You see what I'm saying. So I'm all about ACEs and ARBs, sglt2s and Finero. That's my arsenal. Of course there's a good effects of GLP-1, but then there are some legit side effects to these medications and someone had a rapid weight loss. You got to keep an eye on them. You can't just let them, you know, give them out.
Speaker 1:It's not just a bandaid that's going to fix everything. I mean a lot of you know. These meds also have a high rebound effect if we're not changing behavior and lifestyle in addition to so yeah well, honestly, you know not, you know like I'm a big fan of lifestyle, a huge fan of lifestyle.
Speaker 2:So I'm not like a, like a big, I'm not like just another pharma agent. You know I'm saying I'm more about managing lifestyle and managing things like social determinants of health and other things too. But I've seen patients actually take their health seriously and lose 30 pounds and you see them diabetic medications come off of. You see their bodies autocorrect. When you take that absolutely um and again, like, even like uh, glp1, the ozempics and all them, you know what you're. What it's actually treating is metabolic syndrome.
Speaker 2:Right the metabolic syndrome that these patients have, and so that's what it's really treating so um, and that's what lifestyle can do as well too but, you're right, I think, like that's what it's really treating so and that's what lifestyle can do as well too. But you're right, I think, like that's the conundrum here, like once we do the GOP ones, are we going to give up our lifestyle modification as a first-line agent? You see what I'm saying. Just jump to just GOP ones. But again, they had good effects on the kidney as well.
Speaker 1:Yeah, I'm a big fan. We know it does do a lot, and kidney disease can cause heart disease. Heart disease can cause kidney disease. I think when we have our focus on you know I can. If I slam my finger in the door, I can. I can take a pain, med or or, and I can take my finger out of the car door.
Speaker 1:Yeah, yeah try to fix the root cause where possible. Um is really smart, you know, and it's interesting, interesting too. You know where you're. You also talked about, you know, in this space, in this place, that we're in in the industry where we're really seeing, uh, some, some big uh or new improvements in terms of innovation. And you and I've talked before about tech in the space and I know you work with a tech company. I'm a big fan of what you're doing with the Aleo patch. Can you talk a little bit about the role of tech as it pertains to the kidney and dialysis space?
Speaker 2:Yeah, so I'm actually a nephrology medical director for Alio and they make the smart patch, which is essentially the patch, and I have it here If you want to see it let's see here. I should have had this prepared.
Speaker 1:I'm literally opening a box right now, but let me show you here you know, I think it's so cool, you know, in a setting where we know for the to a large degree, for for patients for whom it's uh, it's feasible, home dialysis, uh can give people a better experience and more control. I just I'm such a fan of of your allele patch here.
Speaker 2:Yeah, yeah. So the patch is really simple. If those of you that know what dialysis access is, it's a fistula graft that goes on your arm. You essentially place this patch directly on the fistula. It comes with this and it comes with a smart hub at home that connects automatically. It's cellular enabled. You have a hub at home and it connects automatically and it automatically sends all information to the cloud.
Speaker 2:Currently, the patch smart patches is FDA approved for monitoring serum, potassium, hemoglobin, hematocrit, skin temperature, as well as auscultation of the fistula.
Speaker 2:So the fistula that's running there, the blood flow, it actually can monitor that and tell you if there's flow or no flow in it.
Speaker 2:So it's almost like and it does it all non-invasive Okay, so that's what's super cool about it Non-invasive and it's specifically meant for the dialysis access market. And, being an interventionalist, I was like this is awesome and it monitors the readings every I forgot what it is every several hours, I think it's three or four hours, and it sends the readings up to the cloud and any alerts that you know, any readings of, say, high potassium or you know, low hemoglobin or whatever can be sent directly to a clinician or clinician team to monitor that patient. Also, I'm a big fan of remote patient monitoring as a whole because, like, once you get good sets of data, you can start to seeing real life trends, right. So sometimes, like say, with the potassium monitoring, right, Like, we all know that dialysis patients run high in potassium because their kidneys don't filter anymore, so the only time we get the potassium off of them is on dialysis session, which is typically three times a week.
Speaker 1:We can pause there, because I think a lot of our folks don't know just how serious that is. Potassium gets too high, I mean it'll kill you. Yeah, that's how you execute prisoners right.
Speaker 2:You give them high doses of potassium. And when you give them high doses, of potassium yeah, it offsets the electrical activity of your heart and you go into cardiac arrest, right. So high potassium can actually kill you. So but the thing is you're like, okay, when is the high potassium happen? So if you have a monitor, say, potassium, that's continuous, you can actually say, oh, you know what Sunday nights, on the weekends, when you're on, you have two days off.
Speaker 2:Your potassium is really high. Maybe on Sundays you need to be more careful with your diet. So you actually have the dietician yes, you know, cater it. And that's where I think, uh, you know, uh devices like the allele patch do, is they? They go into the, the realm of personalized care, right? So instead of giving you know, uh, you know template nonsense to everybody, you know, just to everybody, like you need to do this and you need to do this and everyone needs to do the same thing, I'm like you know what some people, maybe ethnically or regionally or just personally off, are different than others.
Speaker 2:You see what I'm saying. So telling them, tell my population of, say, mostly hispanics to not eat guacamole, which is like like, which is all no, you know because it has avocado in it. You see what I'm saying.
Speaker 1:It's like kind of sucky you. You know what I'm saying, yeah it's a customized approach and I also, you know, it seems to you, can tell me if I'm, if I'm off, but it seems to that you know some of our, some of our nephrologists are are leery of sending people home for dialysis because they lose some of that eyes on.
Speaker 2:Yeah, and that, to me, what I love about the Leo SmartPak is that it goes home with you, right? So there is an eye on that patient. And also, what I've realized is it actually provides reassurance to the patient themselves that someone's got an eye on me.
Speaker 2:It's something that's wrong with me and it goes there. And even from the perspective of like monitoring the fistula and again, I'm an interventionist, so I know a lot of people are here are in the insurance game, right. Um, interventional procedures are expensive and if these dialysis accesses go down, you're you're going to be billed up.
Speaker 2:Your, your insurance is going to be billed another procedure and different now you're going to have a catheter in your neck and yep yeah, and they're going to miss a dialysis and they may get a hospital. And if they're in a rural market where there's no, there's no basket outpatient vascular center, guess what? They're going to the hospital.
Speaker 1:You're going to be charged that so something like that on a general floor yeah yeah, I mean medical floor yeah yeah.
Speaker 2:So it's like it's a. It's so complex. So, again, that this gives that personalized care, give you that early, early um, excuse me, early adoption, uh, early detection, excuse me, and that way you can actually have actionable data and keep, keep it going, you know. So that's what I, that's what I love about my um, my, my involvement with that company. It's it's forward thinking and I don't say they're, it's in the space of not just kidney disease, I mean, or dialysis, it's. It's going to branch out into chronic disease eventually.
Speaker 2:And I can imagine, like an elio smart patch on somebody just sitting there and you know, you can look on your phone eventually and see what you did. Now, right now they don't have a patient facing app, they have a clinician facing app or clinician portal. But at the same time, I can imagine, at some point, the involvement of this into something greater. And again, this has no needles, no detection, none of that kind of stuff. It's non-invasive. So they put it on the, put it on your arm and on your fistula level of cool there doc yeah, yeah, it's super cool.
Speaker 2:It's super cool. But you know, to the great grander scheme, I think I think things like remote patient monitoring are so crucial, like I know you guys, a lot of you guys, are payers, right, um, and there's typically codes for rpm, right, remote patient monitoring codes and all that rtm codes, codes, therapeutic monitoring and things like that. But to me, like, if you can get these data points, more data points on your patient, the more you actually know what's going on, right? So, for instance, for instance, like blood pressure, like most blood pressures we take in an office are complete nonsense. You see what I'm saying. They're complete nonsense. I mean, you just walked in, you know, you just paid a $, you know $50 copay. You ran in from the freaking parking lot. Your wife just yelled at you. Yeah, I figured out. Your wife just yelled at you and then let me get a blood pressure. You know what I'm saying. And so that's not a blood pressure. Yeah, so you need to be relaxed.
Speaker 2:And there's a whole technique I go over when I tell my patients how to take a blood pressure, because I and you know something like that remote patient monitoring.
Speaker 2:When they're monitoring blood pressures at home, I I recommend them monitoring certain uh using certain products and whatever um, and I don't get. But you have to establish for a physician, you have to start with an rpm program to actually, you know, utilize it, because it requires about 16 readings a month for the physician to actually bill um to the insurance. Yeah, it's not so long, it's not convoluted. Excuse me, but it's not as simple as I just get my patients to actually document their blood pressures themselves on a piece of paper or I get an app that that enables that um, but at the same time, like um, I think it should be a reimbursable thing because, as a physician, all of a sudden I'm getting real readings at home in their real life and and that's their actual frigging blood pressure, whereas the blood pressure you get in a clinic is just rushed, it's done, I'm telling you random read that doesn't give you a whole lot of absolutely.
Speaker 2:And then you see clinicians making decisions. Excuse me on those.
Speaker 1:Based off of that.
Speaker 2:And I'm, like you know, like first off to me, like I need to verify, you know, if I'm going to start a third blood pressure agent on you for your blood pressure, I want to make sure you're taking the first two. So, grandma, bring in your bottles, let me make sure you're taking the first two correctly, and then I'll start this third lead agent. Secondly, grandma, you just came in my clinic and you're nervous and you're anxious and you're cold because AC is too high. Let's get some blood pressure readings at home before I start adding additional agents. You see what?
Speaker 2:I'm saying To manage blood pressure. So to me remote patient monitoring should be a little bit easier. But it is a kind of a not convoluted but it's very difficult for a lot of practices to establish it. But as a payer I know you're the same thing. I scrunch off a little bit. I also find.
Speaker 1:You know, one of the headaches that I think frustrates a lot of our nurses is just how hard it is sometimes to get approval for folks to have a blood sugar device. I mean you can get a. You know, I can get a cheap device at a pharmacy at 20 bucks and check my sugars, but a lot of people. I can get a cheap device at a pharmacy at 20 bucks and check my sugars, but a lot of people. I mean my husband. If he had to prick his finger, he's not watching so I'll tell you he would pass it. He passed out an ultrasound.
Speaker 2:Okay, that's between us, 50 people only. Yeah.
Speaker 1:But some of our members won't check their blood sugars because it hurts over time.
Speaker 2:You know, and you think about that too, and the role I like I actually like earlier this year, at the beginning of the year, I actually ordered a dexcom because I started my patient seeing it. So the dexcom. So you have two companies on the market.
Speaker 1:Well, I think it's probably more, but freestyle libre is another one.
Speaker 2:But I actually got to mess with the dexcom. I messed with it for about a month or something and and it was really fascinating. You know of course that uses a little needle put in there, but the application wasn't terrible, doesn't hurt. I had one pass. It kind of irritated a little bit for the week I had it on. But the sheer fact that I had my blood sugars at all times and actually could see that my blood sugar, that certain foods made my blood sugar run higher than others, you, that certain foods made my blood sugar run higher than others.
Speaker 2:You see what I'm saying. I had a sushi night on my birthday and my sugar stated like oh, I know, I had to give up sushi. Oh yeah, what I'm trying to say is normally, I was normal because I'm not diabetic, I just bought it out of pocket. So you get to see your own blood sugars and what they do and how fast they come down after, after a meal, and certain foods act in response to exercise yeah, yeah, a hundred percent and so like.
Speaker 2:All that kind of stuff to me is like that personalized care, um, customized care, um, and understanding your own day, your own data, is so crucial Like a pin fricking. Yeah, I would never. I was like when I had that passion, I was like I can't imagine sticking your finger over and over again.
Speaker 1:If you think about it, if you want to change anything in your life. It's hard to do if you don't know where you are to begin with. So tell somebody you know most people with diabetes. They see their doctor and they go home and they say, yeah, I should get my A1C down. I don't have a clue how to do that. It's kind of like driving blindfolded. You know I can do that just great, until I hit a tree. But, without opening my eyes, I can't tell what decisions to make while I'm driving down the road.
Speaker 2:And it really depends on the individual. So what I've realized is some patients do care about their health and some patients don't. So even for those patients that don't care about their health that much or are not in tune to their health at least that patch with the Libre in particular, or the Dexcom or Libre, can alert you at high blood sugars or low blood sugars, so like if you're you can set it to sugar above 300, that means take an additional 10 units of insulin, you see what I'm saying.
Speaker 2:Or sugars below 70, you're about to frigging pass out. Take something you see what I'm saying so it can alert you to a bad outcome. So even those patients that aren't as in tune to their health and really about having that perfect glycemic control, it still gives them a good alert system so that you know, you can check it out. And then, even then, what I love about that kind of stuff and even the blood pressure monitoring that are on apps, is I tell them hey, give me your phone, Let me just roll here and see what's going on, so I understand my patient more.
Speaker 1:Yeah, absolutely yeah. I think you know this field that we've been talking about here in terms of remote patient monitoring can really help to avoid a big problem, because you can see those things coming. What about you talked earlier and I in nephrology, we have some, you know, deserts out there where people don't have access to the specialist Can you share? A little bit about the. You know, I think telemedicine really kind of kicked off post COVID and that's when people couldn't come to the office, right.
Speaker 2:So I started doing telemedicine, really kind of kicked off post COVID and that's when people couldn't come to the office, right.
Speaker 2:So I started doing telemedicine in the office, but I always found telemedicine in the office kind of sorry for the outpatient setting like in the office, like I found it kind of not as kind of incomplete, if you would, and the reason being is because oftentimes you're, you're on the, you're on the phone with somebody that typically is older, doesn't really connect with technology that well. So half the time I'm like staring at grandma's forehead you know what I'm saying. So it's like weird on top of that and really get a good clinical assessment of their entire body On top of that, I don't really know what meds they're on. You know, I don't see the bottles. We didn't get an assessment, we didn't get a blood pressure on them. So I'm not against telehealth at all, like if we can get all those things kind of ordered. You know telehealth, you know for the home environment, go down. Now it's very good, don't get me wrong Telehealth. But like the quick urgent care kind of things I've used it with CVS, like the CVS has a platform for that too.
Speaker 1:I had an eye problem.
Speaker 2:They just prescribed me drops because I knew it was just going to be a little bit of drops and pick it up. I thought it was genius.
Speaker 1:Or UTI yeah.
Speaker 2:Yeah, or like a UTI, but those chronically, those chronic care management. Those chronic cares are people with multiple corpidities that need to be. They sometimes need to be seen personally or with you know better technology because you can't really assess them. So my real good experience with telehealth is when I left my practice and I started. I joined access telecare and I actually do telehealth in hospitals. The way it works is essentially I call into a monitor zoom, literally use a zoom to call into a monitor. They drag that monitor room to room and I get to assess the patient there. Now what's cool is in a hospital setting as opposed to a home setting, a patient is essentially in a controlled environment. Right, I get access to all their blood pressures, I get access to their chest x-rays. I get access to their lab daily labs. I can zoom in and actually take a look at, like, their swelling and I can just have the nurse do the pit of edema thing where they check.
Speaker 2:You get that kind of a full assessment. So I always say when I'm doing telehealth in a hospital, I feel like I have better, I feel like I have like about 95% of my adequacy down. You see what I'm saying, or my I'm at 95% of capacity. That 5% is really due to the fact I couldn't do that physical exam Personally couldn't physically put your hands yeah.
Speaker 2:Outside of that, though, for me, like you realize, it's more apt for different professions. So nephrology we're numbers, guys straight up, like I need numbers, I need labs, I need vitals, and that's it. Some people.
Speaker 1:You know, obviously a surgeon can't do that like pulmonology or where you gotta listen well even then.
Speaker 2:Well, I know you can like our monitor actually has a little stethoscope where you can put them onto their lungs and all that kind of stuff too. Um, but what's cool about you know? Uh, from the cost savings perspective, is, first off, these rural hospitals cause that's who I serve is these rural communities, you know, in Arkansas and Virginia. Um, they're in the middle of nowhere, right? So oftentimes they went in the middle of nowhere. The relatively small hospital. They don't have all the specialists, and so that dialysis patient or that AKI patient that shows up, a kidney injury patient, shows up to a hospital, they have to ship that patient two, three hours to the main main town or main city. So, first off, the hospital loses out on the money that they would have gotten to. They have to, you have to provide transportation to another facility and then the bill.
Speaker 2:And then also like, if the patient's unstable, like, do you really want to go for two or three hour ride when you're at?
Speaker 2:oh yeah you see what I'm saying. So you provide that level of care, uh, and you can. You can touch more lives at that. You know, with telehealth in that scenario, especially with someone who's all about numbers, and so literally I'm starting with someone on dialysis today via this um. So, and I try, you know, I try to um always try to be nice and like and I try to let my personality come out in these kind of um when I have those engagements on telehealth for them, so that I can make them feel comfortable. You don't want to be a robot on here, I don't want to be old and say max headroom, but you don't want to be max headroom on here and be like you know, like you want to be engaged, you want to be there. But the thing is, what's weird is, I think, like for me, like I think a lot of these companies do, take more experienced doctors because, like, when I step into an icu via telehealth and a monitor, I can smell the room.
Speaker 1:You see what I'm saying like absolutely, yeah, I can smell the room.
Speaker 2:Like I can smell that you've got time in the trenches and so you wonder where the technology is going, so readily available. They're going to take these kids out of practice, right, like out of straight out of residency, out of residency or fellowship, and like throw them in there. So it's gonna be interesting to see, because I again I have that 3d or 4d patient Doc.
Speaker 1:We're seeing the same thing in nursing the old guys. You know, I still feel really fortunate. When I got out of nursing school I had some fantastic mentors, nurses and doctors who were really experienced, and a lot of those folks are just gone.
Speaker 2:Yeah, I mean there's a certain level of experience. But I think there's gotta be a certain level, like a certain you know baseline experience in the trenches, before you can say but you know the thing, that we're going to see how the market responds to it eventually and if it continues to grow or not. But from a lifestyle perspective it's super cool. I get to be flexible.
Speaker 1:I think about patients in Alaska. You and I have talked about that Great pay to go up there for a week, but they have. I mean, I have a girlfriend, she's a nurse practitioner and she takes a sled dog to go into different villages to see people you know once a month hilarious.
Speaker 2:Yeah, I know I've heard some horror stories out of alaska, like I was like really, that's america, you know, like I was, like you know, I hear these stories about like some of the care they receive and stuff. It's like wow, wow, because they're really far out there. Not that it's a bad place, I heard, it's really beautiful, but for access to care and I've even seen these yeah, so, ladies, locums, I remember like there's some jobs out there that pay tremendously well for you to fly two weeks a month can really help in a setting where we just don't have enough to go around.
Speaker 1:What about? I know, a really sexy topic right now is AI. And I know you do some work with the folks over at DeLorean AI. I've been following them because of you, by the way, oh is that right? Yeah, so really excited about what they're doing. Can you share a little bit about the role of AI in this type of setting?
Speaker 2:Yeah, yeah, so, like with AI. So I'm I'm chief nephrologist for DeLorean AI. It's a medical AI platform. They have they have modules for, like, um, um, for uh, you know, uh, cardiovascular diabetes, and they have renal renal platform as well. I'm on the renal platform side.
Speaker 2:So I'm not writing code, I'm not, you know, I'm not the guy writing it, but I'm getting to see its actual implementation into care, which is super cool. You know, like and I'm not even care, excuse me, I wouldn't say that but like it's implementation into healthcare as a whole, right. So what they do, we have a partnership with intervention, innovative renal care and um. We're actually in some of their dialysis and everything. So it's super cool to see that, the implementation of it getting it out there.
Speaker 2:But what's cool with our platform is that we can identify those high um, those high risk patients, right, so that the ai can actually, through ml and everything, can actually identify patients that are, um, you know, high risk, right, so we put them into categories high risk, um, low risk and transitional risk, right. So, again, you guys set their insurance. You know high risk, right, so we put them into categories high risk, low risk and transitional risk, right. So, again, you guys said their insurance, so you know the high risk patients, your lowest patients, but there's a set of patients in the middle that are just in transition from low to high or high to low right, and that transition is very quietly and just like two months later you're in the hospital and now they're this high risk patient forever right.
Speaker 1:So you want to get those my mom has had any high cost claims before.
Speaker 2:Yeah, and now all of a sudden, they're a high cost agent, right. So for us, like, being able to identify those patients is crucial. So one of the things we were involved in is, like fluid overload admissions to the hospital for fluid overload One of the biggest cause of admissions for dialysis patients, right? So you know, what I see is the biggest application of AI, or one of the biggest excuse me, there's going to be tons is just the sheer amount of the sheer ability to collect massive amounts of data in one place, Do you?
Speaker 2:see what I'm saying and able to like as we see, I think the siloed nature of healthcare is so obnoxious, you know like literally the hospital has its EMR, the clinic has its EMR, the private practice has its EMR, the dialysis unit has its own EMR, so none of that communicates Now with us. In particular, we work with the. You know IRC, you know EMR, and we're able to collect a data on the patient and tell you we think this is a high risk patient. Now the thing is, you can't just tell people this is a high risk patient, right? So what I do, what I help them do, is come up with clinical dashboards and make it clinically relevant, right? So instead of just saying it's a high risk patient, I'm telling you guess what?
Speaker 2:For the last two weeks they've been five kilos over every treatment. You see what I'm saying. Or, um, they haven't their dry weight's shifting, if you know what a dry weight is, but essentially it's too much fluid you're supposed to remove and you can, or they've missed three treatments and this is where they're going to end up.
Speaker 2:Yeah, and so I give you clinically actionable uh data. You see what I'm saying. So they're telling you that this is high risk. But then I'm then as a clinician, I've designed the board so it's like oh, this is why it's high risk. They've missed three treatments in the last few months. They had a hot pollution last week. So you get all this data put into one spot in a nice clean clinical dashboard that makes it actionable for you. You see what I'm saying. So I think that's one of the applications of of ai for sure is the collection of data, making it clinically relevant for the physician and kind of going from there now as far as other aspects of ai which think are cool and those are the cool things we do at DeLorean, but outside of that, I actually just went to an AI and healthcare meeting on Monday in Austin.
Speaker 2:It was really fascinating because we all want to believe that AI and healthcare means that you know, essentially automate my brain and you know, and it takes over the clinician spot, right, but in, in actuality, there's so many issues in health care that that are non-clinical, right like look at like to me, like we talk about burnout. Clinical workflow is horrible in hospitals, right, that's like the clinical workflow is inefficient, stupid and just dumb and it's doesn't, it's not cohesive to like a you know practical usage.
Speaker 1:Yeah, that's gonna feel like you're wasting time.
Speaker 2:Like you know, why am I wasting for this call to come back? Why am I wasting for a fax? You know what I'm saying. All this kind of stupid stuff. But like that clinical workflow could be so better augmented with AI, right, say, with scheduling issues. Or the people brought up, oh, making certain doctor's notes are actually accurate. You know, sometimes doctor's notes are off. Instead of left, they said right, or maybe they didn't mention left or right foot. You see what I'm saying. So augment that. Well, it could be used for revenue cycle management, right, proper billing and all that kind of stuff as well too, the safeguard of sorts, yeah, the back end.
Speaker 2:I remember talking to one of our friends who's in AI and it's like everyone wants AI to, like you know, make the decision or, like you know, take over care or whatever, and notice that it's the low hanging fruit in medicine that really needs that automation to make life a little bit better.
Speaker 1:Scheduling OR times.
Speaker 2:You know how hard that is sometimes Scheduling OR times, knowing what ORs are open for you to play or to do.
Speaker 1:Just scheduling a meeting on Zoom sometimes yeah.
Speaker 2:Or just, in fact, like something as simple as like let's just talk about scheduling. It's like it's like okay, you know I have clinic today, oh, my 1pm canceled. Can we bring in that patient that missed yesterday's appointment today? Do you see what I'm saying? But ai can be like guess what, a 1 pm time slot just open, let me call, like this other patient, and see if I can get him in. And again, these are subtle things that could probably, you know, augment work more efficient, more powerful and we're able to deliver, yeah absolutely.
Speaker 2:And so in just looking at emrs and I'm doing emrs and you know I'm doing I'm looking at emrs right now at hospitals. Some of them are so antiquated dude, like it's like 1990s stupidity.
Speaker 1:And they still don't talk to each other.
Speaker 2:They don't talk to you, but I'm saying like even the usability from the clinician standpoint is so antiquated that it actually impedes how fast I can see that patient. You see what I'm saying. If the data is not presented easily and accessibly, like I have to fish, click this button, click this button, click this button. You know.
Speaker 1:So it's like Makes a difference in terms of how many people you're able to see and to help.
Speaker 2:Absolutely yes, and honestly like there's EMRs like Epic which are very customizable and I got very proficient at and I have all my templates and they call some more phrases in, like you know.
Speaker 1:I can see 35 patients a day, or I can see 20 patients in a day.
Speaker 2:It depends on the clinical workflow right?
Speaker 1:Am I covering multiple hospitals? Am I covering different EMRs?
Speaker 2:What EMR do you have? Who's calling me, who's not calling me? You know all these little things, these factors, so you can actually make doctors way more efficient and see more patients and spend more time with the patient than on EMR right, Wasting their time on EMR with things like AI and things like that too.
Speaker 1:So Okay, so I have another really hot hot topic before we go to question and answer. You know you also do some work with Icona, yeah, so I love VR. I love working out in my little VR. I go all over the world and work out in the morning, but there's some really cool applications for vr and healthcare.
Speaker 2:Maybe you can share a little bit about what you're doing there yeah, yeah, so I'm actually a physician advisor to ikana health and if you don't follow temper for so tim fits practice with uh kidney verse, you need to. He's the ceo of ikana health, but he does. Yeah, yeah, his, he presents. All his posts are very meaningful posts. They present latest and greatest news and kidney, kidney trends, um, and like different things that are going on in the market. So you need to follow him for sure, um, but uh, many years ago well, many years ago, like three or four years ago, he asked me to message each other on linkedin. He asked me to be a little advisor to his company. So it's cool. Now we have like an annual coffee in New York. For some reason, I always want to go into New York in a year and I wind up seeing him and we have a coffee together. But, but, a super cool guy and so his, his, his company, is about patient education and that's something I realized is so crucial for the implementation of good healthcare Right.
Speaker 2:One is the fact that you know we have to identify the patient and their needs in order to properly educate them. One a handout is useless. You know what? I'm saying, like you walk out of a doctor's office with a page, several pages of nonsense, you're guaranteed you're going to throw it out or just leave it on your desk.
Speaker 1:If you're uremic and you can't think straight. But even then, like it's like, how do you?
Speaker 2:process that, right, you're going to give someone a thing about low potassium diet. You're going to tell them all the stuff they can eat or what they could eat. What about this? How much of this? You know these, all this kind of stuff. But also their learning comprehension, right, like, not everyone's learning comprehension is that great, you know. I remember hearing the average american reads at a seventh grade level, right, so you can't be all like I. You know third grade. Well, it depends on where you're at, yeah. But yeah, I remember hearing, like an average newspaper is written at a seventh grade level, right?
Speaker 1:So, like they're making news.
Speaker 2:Yeah, but so you know you have to meet the patient where they are, and so I kind of helped use the concept called learning science. So learning science is essentially understanding how people learn where there'd be various facets of their brain the cognitive, the emotional, whatever the, the impulsive, whatever parts of their brain but also takes into account how they learn their educational factors, but also something called a forgetfulness, forgetfulness, forgetfulness, curve, right. So there's a point where you learn something, like you and I talked about a subject. Three months go down the road and you forget it. Right, maybe you forgot about the phosphorus diet, and that's something that's hilarious. You see these on dialysis patients. We see dieticians all the time. I'll ask them are you watching your phosphorus? And they'll be like what's a phosphorus?
Speaker 2:yeah literally they'll say that you have for five years on dialysis you know what I'm saying like it's crazy. So there's a component there of like a forget from this curve and they they actually have their platform kind of re-engage at certain key points to make sure they reiterate those kind of things now they've won almost completely into the vr realm, which is virtual reality realm, um, and they help augment um, augment, uh, like learning for particularly home dialysis, you see I'm saying they can do other modalities, but the whole trend is with home dialysis do dialysis at home, not in the center is with home dialysis Do dialysis at home, not in the center.
Speaker 2:You have better outcomes when you do dialysis at home. You live longer, have less restrictions on your diet, all that kind of stuff. So you have better morbidity and mortality when you do dialysis at home. Oh yeah, the thing is like, you need that support, you need that training. So imagine putting a VR headset on and being able to understand how to cannulate yourself, stick yourself for knee dialysis or be able to see a peritoneal dialysis machine in your house and how it would look.
Speaker 1:They've even gone into the realm of cost savings from our side, from a lot of the folks watching. They're big. There's some significant cost savings.
Speaker 2:Oh, absolutely Like a VR and not to mention that they're going into staff training as well now, so they're actually helping train staff, which helps with staff retention, right? Like we all get frustrated with employees that forget what you taught them, right? So if you could retrain them or initially train them with using VR? We did a video I don't know if you saw it, but it was literally about virtual reality and dialysis and I posted it on LinkedIn.
Speaker 1:Yeah, it showed the setting in the home. I think that's so cool.
Speaker 2:Yeah, linkedin. But yeah, it showed the setting in the home. I think that's so cool, yeah, yeah. So me and him talked about it and stuff and you know, um, and actually the ugly actually respond pretty well to it. You know, I was surprised because I always thought it would be kind of confused, but they actually respond pretty well to it. So virtual reality and in training sessions and learning can well, and there's some use.
Speaker 1:I'm seeing, uh, seeing some, some facilities. I'm seeing some facilities. I'm seeing some talk around the use in terms of just boosting people's mood. Yeah, yeah, I've heard that too. I don't know if.
Speaker 2:Icona is doing that yet Again. I'm a physician advisor to him, but I think like yeah, I've heard that before, put you in Costa. Rica. You know, on the beach, you know, yeah, I can imagine. Yeah.
Speaker 1:Well, so here's a question that came from somebody in the audience is asking about you know, yeah, yeah, I can imagine. Yeah, well, so here's a question. It came from uh. Somebody in the audience is asking about you know, how do we get the majority of patients to understand, uh, about some of these monitoring devices and things that we've been talking about? How do we get uh and I it's a topic I love how do you get people to pay attention to their own metrics and their trends and why? Yeah, so I have this, I have this.
Speaker 2:I have this, the saying I think of, and it's like I think most people, most people, don't want to be healthy. They just don't want to be sick, right. So they're not actively involved in it, right, they don't want to so. And the problem with rpm and in general, reprimand patient monitoring, it requires patient behavior, right? So if you're going to do something, you have to take your own blood pressure, you have to weigh yourself, that kind of thing. And that's where things like the smart patch come in, because it's wearable, right? So you take the, you can get the readings, you can get as many readings as you want, as long as you get those readings. Yeah, there's no, there's no patient behavior. You just put the patch on and then you change it every three, seven days. So I think that's one of the ways is when we move, move metrics from, like you know, having that involve patient behavior to making it more wearable. Do you see what I'm saying?
Speaker 2:There's a patch that you can actually augment better behavior there too. So but yeah, I agree. And the other component is like, even with blood pressure, I'm a huge fan of home blood pressure monitoring One. It engages the patient makes them responsible. I literally tell them them hey, I google it on their phone and say this go buy this fosters their learning yeah also like, I think, like it's weird, I think even patients to me like they need a buy-in right, meaning like it's like the pressure cup I recommend is about 35 bucks at walmart yeah, I tell them put it on their app.
Speaker 2:I'm like, go go pick this up, right, so I take all the decision tree out. They don't have to even like frigging, like tell them look for a blood pressure cup Like this. Go get this one, right, but that $35 is their $35. Right, it's not.
Speaker 2:Dr Butts the blood pressure monitor. It's not, it's not United blood pressure cup, it's not, you know, empowers them in a weird way to actually take the step, to actually purchase. And then they go there and that they go up and go to the higher one that I usually recommend, that's bluetooth enabled, that connects to their phone. Then they got on their phone dude and when you have that blood pressure, blood pressure readings on your phone and you can, you can see averages, you can see trends, nights and days, you can see all this kind of stuff all of a sudden you have real life data that they can actually get personal feedback.
Speaker 1:And they can choose to do something there. I think that's such a huge topic, you know, because we all find time and energy for the things that are important to us personally, and so part of our job, I think, as a clinician, as clinicians is to help people understand their personal power over their health and then, to your point, empowering them to. You know, take control over those, those kinds of things.
Speaker 2:Yeah.
Speaker 1:We have another question here and, gosh, I know in this five minutes that we have left. Feel free, you know, if you have some questions you want to put in the chat, feel free to shout those out, cause we'll take those. One of the questions that we have here is you know, where do you see the role of the nephrologist evolving? What is the nephrologist role going to look like, say, 10, 20 years from now, and how is that going to be different? No, crystal ball, you do have one behind you, right, crystal ball? Yeah, somewhere down here.
Speaker 2:Yeah.
Speaker 2:So I don't know.
Speaker 2:I see the role of the clinician like again changing over time, so as as you augment, you know, clinical care with technology, whether it be more, more data or like AI or whatever it may be the clinician hopefully will be able to spend more time with the patient.
Speaker 2:But also, I think the approach of the patient has to change to just a physician making decisions or to one of a clinical care team right, a clinical care coordination, right. So there has to be a team. Like there's so many things I want to do for a patient, but if they can't afford that medication, the copay is too high, or they can't get transportation to the clinic, or they're having insurance issues, there's open enrollment and I don't have access to a social worker to help them out, like there's so many aspects there. So what I hope to see is, like there to be. I think the doctor should be still the head of the, of the, of the treatment, of the of the pyramid, but, um, there's got to be a clinical care team around him or her, right integrated clinical care team yeah, and integrated, and that's huge to me.
Speaker 2:So integration is huge. I practice at ut health san antonio. It's a university system, it's all.
Speaker 2:So, essentially, it's essentially when I get on the EMR I have access to all their labs, all their doctor's notes, their physician notes, their cardiologist notes, their primary care notes, their hospitalizations, so I don't have to reorder things. I can see trends over over over, over over years or a decade, and so I can see that over time. So, integrated health I don't think, I honestly don't think you can have value-based care without integrated right, because if you don't have integrated health and coordinate, you can't have coordination. How do you have coordination? How do you know? How do you know what the cardiologist did? You know what I'm saying and you know is it worth putting a stent in that person's leg? They're 85, you know like and. But the vascular surgeon thinks it's worth it, but the primary doctor's like what are you doing?
Speaker 2:you see what I'm saying so there's a lot of things there where I think, you know, maybe a clinical care team is going to be focused and that and that's going to be honestly specifically to people with multiple comorbidities or later ages, like clinically. For clearly for me as a physician, as a as a as an individual, at my age, in my mid-40s, like I can, uh, you know, I only need a pcp, that I need to see once a year. You see what I'm saying? It's fine, but as I get older, I mean, hopefully I never have to do this, but if you're a 70 year old grandma with congestive heart failure, diabetes, high blood pressure, stroke, all these other 10 medications, you need some clinical care coordination to make sure everything's going on because, it's not.
Speaker 1:It's not going to be and it's too overwhelming for family members to step in yeah, and it can cause a lot of a lot of harm, even yeah yeah, yeah, I have. What about uh? Final question here um is asking about uh, where do you see dialysis going in the future? Um, is there any innovation in terms of dialysis?
Speaker 2:I mean, there's plenty of companies I think about the WAC.
Speaker 1:I still wanna see a WAC in use. Where a artificial kidney.
Speaker 2:Oh, you're talking about the AWAC company. You're talking about them. Yeah, they're an interesting company as well. So my first introduction to innovation in dialysis was really outset medical and the Tableau device.
Speaker 1:And the home just smaller more portable machines.
Speaker 2:Well, it's not just home. They have an all-enterprise solution. So their solution can be at home, it can be in center, In the hospital.
Speaker 2:In the hospital, it could be in the ICU and all that kind of stuff, but for the longest time. The inherent problem with dialysis units is that it's the inherent cost of doing dialysis Right. So it's like so you have to set up a huge unit, you have to have a water room and then you have this dialysis machine Right, so you have to have an RO system that's separate and literally a room dedicated to you know, essentially filtering the filtering the water itself before it even gets to the machine.
Speaker 1:And even start your dialysis Yep.
Speaker 2:Yeah and so. So what what outside did was kind of change up the game and made it in all in one box kind of thing, okay, so you didn't have to build a water room for it, right, which was super cool. Now they actually flew me out to san jose, to their headquarters, and I got to see their device and all that kind of stuff. So it was super cool. But when I got to see it, compared to other devices like side by side because that's what they did in their, their headquarters um, I was just like this is like.
Speaker 2:This is like. This is essentially star trek next generation. Everything else is like star trek. You know um, you know 1960s. You see what I'm saying? It's like yeah because of the technology so good and the user interface is so good, like the screen is like an ipad. Uh, the steps involved due to home dialysis. You talk about home dialysis but there's a burnout at home too. Right is a patient burnout and everything, so there's less steps in in using it. Um, so that?
Speaker 2:was my first time you know, first time actually seeing innovation in kidney care. Now the machine is substantially hot, more expensive than the traditional machines it is, but you save yourself a lot of room and everything else like that. And what's interesting is something as simple as that user interface. That's not something most doctors think of. You see what I'm saying. Like that simple as that user interface, that's not something most doctors think of. You see, what I'm saying Like that's that the user interface being better means it's more apt for home dialysis, for the retention of that patient doing home dialysis, but also for a dialysis nurse who's busy. If the interface is easier it makes her life so much easier. You see what I'm saying. Oftentimes I think doctors get infatuated with numbers and statistics and all this kind of stuff. I'm like sometimes the bells and whistles really do make a difference as far as you know how well there's other companies to.
Speaker 2:There's quantum was a quantity, quantify, quantify. There's another Dallas machine on the market as well too. I think they just got FDA approval. There's another one, diality. Diality is run by a doctor, dr Osman, I believe it. It is it's where he's actually a nephrologist that formed it. I think they just got it coming close to the FDA approval as well, and most of them are outpatient, not inside in the home yet. Um then, you're talking about awap technologies, awap technologies out of singapore. They're essentially making. They call what's the it stands for.
Speaker 1:Awox is an acronym, right, so um yeah, something where art something artificial wearable, yeah kidney.
Speaker 2:So it essentially is. It's like almost like a purse sized um, a purse pack, yeah, a little fanny pack, a little bit bigger than the fanny pack, but it's like peritoneal diagnosis mechanism that has that the dialysate, which is the fluid that the blood grows across, is recycled. You see what I'm saying. So typically you have to use gallons and gallons of fluid, of water or dialysis yeah, big bags. But in this one in particular they recycle and they have some sort of technology there. And then the other one I would say is out of Singapore, as well, as Next Kidney. Next Kidney is another dialysis company. They're making a more portable dialysis, a hemodialysis thing, where it's actually it looks like almost like a printer. I saw her at a conference. I met the CEO there, and it looks like a printer and it's a. It's almost the size of like a carry-on for for like when you, when you go fly.
Speaker 2:Yeah and so, but you can just take it anywhere. You see what I'm saying. So you can take it to work and get dialysis there. Now those two I don't think AWOC or KittenX Kidney have that theory of approval yet, but those are just interesting technologies out on the stage. The way I see dialysis going is improvements in user interface, bringing those machines smaller and smaller, the RO systems staying at home, getting them smaller and smaller and then hopefully at some point that can eventually turn into an artificial kidney. I think people are wanting the artificial kidney tomorrow and I'm like I think it's a progression that has to happen.
Speaker 2:Regression and evolution. Technology gets smaller and smaller to to to, you know, to get to sit at home, in your at home, to where it's wearable, and walking around to where it eventually becomes an implantable. And my friend of mine actually is running a company called Nephrodite, where he's actually doing something somewhat implantable as well too. Um, but yeah another company out there as well.
Speaker 1:So very exciting. We didn't even we're out of time, but we didn't even get to talk about the innovations that's happening in uh, the transplant space, uh, which oh yeah, I'm not as versed in the transplant space, but of course the pig kidney and all that kind of stuff as well. The artificial the pig kidney. That was a big one, and so yeah, yeah but're out of time. That would be a robust discussion as well.
Speaker 1:Well, I just want to thank you so much, Dr Kossumbat, for joining us today. It's always great to get to connect with you and I know how busy you must be. So thank you so much and for our participants. Feel free you can certainly share this around with people who need to see this webinar today, and don't forget to subscribe to Dr Kassam Butt's channel there on YouTube and follow him on LinkedIn. Dr Butt, how can people find you if they have questions?
Speaker 2:for you. Oh yeah, anytime y'all want to find me, I think LinkedIn is my platform of choice. You can always feel free to message me, friend me or not friend me, but connect with me on LinkedIn and then go from there, always available for like consulting opportunities as well too. So if anybody out there is wanting to know about more kidney care or anything like that, I'm happy to jump on a call or whatever. So cool.
Speaker 1:Yeah Well, thank you so much. Take care of your kidneys and live well. Everybody, thanks for joining us today. Thank you so much, dr bud have a great day okay bye, ciao.