you
you [Music]
life as we know is unpredictable we know
life as we know is unpredictable we know life is very unpredictable we know today
life is very unpredictable we know today
life is very unpredictable we know today life is unpredictable and as a physician
life is unpredictable and as a physician
life is unpredictable and as a physician and a doctor who does pulmonary and
and a doctor who does pulmonary and
and a doctor who does pulmonary and critical care I’m the kind of doctor you
critical care I’m the kind of doctor you
critical care I’m the kind of doctor you don’t want to see you have to be really
don’t want to see you have to be really
don’t want to see you have to be really sick to come see me what I do is I take
sick to come see me what I do is I take
sick to come see me what I do is I take care of patients who have very severe
care of patients who have very severe
care of patients who have very severe illnesses and I’m actually helping them
illnesses and I’m actually helping them
illnesses and I’m actually helping them get back to life a lot of times and
get back to life a lot of times and
get back to life a lot of times and critical illness their vital signs are
critical illness their vital signs are
critical illness their vital signs are abnormal their heart rates lower fast
abnormal their heart rates lower fast
abnormal their heart rates lower fast their blood pressures lower extremely
their blood pressures lower extremely
their blood pressures lower extremely high and people are really dying and in
high and people are really dying and in
high and people are really dying and in this kind of a setting if you can
this kind of a setting if you can
this kind of a setting if you can provide critical care which is really
provide critical care which is really
provide critical care which is really providing support vital support to
providing support vital support to
providing support vital support to patients at the critical phase of their
patients at the critical phase of their
patients at the critical phase of their life you can make a difference when you
life you can make a difference when you
life you can make a difference when you can provide critical care you really
can provide critical care you really
can provide critical care you really need a hospital you need a machine you
need a hospital you need a machine you
need a hospital you need a machine you need high tech monitors but the truth is
need high tech monitors but the truth is
need high tech monitors but the truth is that isn’t the truth you really need
that isn’t the truth you really need
that isn’t the truth you really need expertise to be shared and today I’m
expertise to be shared and today I’m
expertise to be shared and today I’m going to share with you an overview of
going to share with you an overview of
going to share with you an overview of what that can be because you can
what that can be because you can
what that can be because you can actually provide intensive care
actually provide intensive care
actually provide intensive care everywhere to anybody anytime let’s take
everywhere to anybody anytime let’s take
everywhere to anybody anytime let’s take the case of mrs. Pushpa she’s about 50
the case of mrs. Pushpa she’s about 50
the case of mrs. Pushpa she’s about 50 years old she had heard about chest pain
years old she had heard about chest pain
years old she had heard about chest pain for last 30 minutes she’s been quite
for last 30 minutes she’s been quite
for last 30 minutes she’s been quite short of breath has not been able to
short of breath has not been able to
short of breath has not been able to catch her breath she’s had difficulty in
catch her breath she’s had difficulty in
catch her breath she’s had difficulty in walking and then she complains to her
walking and then she complains to her
walking and then she complains to her people nearby saying I’m not able to
people nearby saying I’m not able to
people nearby saying I’m not able to breathe what can I do they immediately
breathe what can I do they immediately
breathe what can I do they immediately rush her to the nearest hospital she has
rush her to the nearest hospital she has
rush her to the nearest hospital she has a low blood pressure and then they
a low blood pressure and then they
a low blood pressure and then they realize that you know she needs to be
realize that you know she needs to be
realize that you know she needs to be treated for possibly a heart attack now
treated for possibly a heart attack now
treated for possibly a heart attack now the question that the doctor at that
the question that the doctor at that
the question that the doctor at that location faces is can we actually keep
location faces is can we actually keep
location faces is can we actually keep the patient here should we move the
the patient here should we move the
the patient here should we move the patient what can we do and that depends
patient what can we do and that depends
patient what can we do and that depends on the expertise of the hospital the
on the expertise of the hospital the
on the expertise of the hospital the doctor and how sick the patient is that
doctor and how sick the patient is that
doctor and how sick the patient is that could be in New York City
could be in New York City
could be in New York City Pushpa might be there she might be in
Pushpa might be there she might be in
Pushpa might be there she might be in Jubilee Hills or she might be on the
Jubilee Hills or she might be on the
Jubilee Hills or she might be on the Outer Ring Road going in a car 100
Outer Ring Road going in a car 100
Outer Ring Road going in a car 100 kilometers from the nearest hospital
kilometers from the nearest hospital
kilometers from the nearest hospital what can we do in that setting when you
what can we do in that setting when you
what can we do in that setting when you are facing a situation like that you
are facing a situation like that you
are facing a situation like that you come
come
come across critical-care unfortunately not
across critical-care unfortunately not
across critical-care unfortunately not just an India but around the world the
just an India but around the world the
just an India but around the world the cost of critical care is unreasonable
cost of critical care is unreasonable
cost of critical care is unreasonable the average cost is about 17 thousand
the average cost is about 17 thousand
the average cost is about 17 thousand rupees on average it shoots up all the
rupees on average it shoots up all the
rupees on average it shoots up all the way up to the several lakhs to the
way up to the several lakhs to the
way up to the several lakhs to the crores if somebody is extremely ill now
crores if somebody is extremely ill now
crores if somebody is extremely ill now this is the reality that Pushpa might
this is the reality that Pushpa might
this is the reality that Pushpa might have to face depending on where she’s
have to face depending on where she’s
have to face depending on where she’s from who she is and which hospital she’s
from who she is and which hospital she’s
from who she is and which hospital she’s in and also depends on how sick she is
in and also depends on how sick she is
in and also depends on how sick she is about 40% of people actually end up in
about 40% of people actually end up in
about 40% of people actually end up in poverty after one episode of illness
poverty after one episode of illness
poverty after one episode of illness where they have to borrow money and they
where they have to borrow money and they
where they have to borrow money and they have to actually change their complete
have to actually change their complete
have to actually change their complete lifestyle sell lands etc there’s a huge
lifestyle sell lands etc there’s a huge
lifestyle sell lands etc there’s a huge gap huge gap between the number of
gap huge gap between the number of
gap huge gap between the number of patients and the number of beds there’s
patients and the number of beds there’s
patients and the number of beds there’s only about 70,000 critical care beds in
only about 70,000 critical care beds in
only about 70,000 critical care beds in India for five million patients that’s a
India for five million patients that’s a
India for five million patients that’s a gigantic gap we clearly have lots of
gigantic gap we clearly have lots of
gigantic gap we clearly have lots of patients extremely sick patients not
patients extremely sick patients not
patients extremely sick patients not enough facilities to actually take care
enough facilities to actually take care
enough facilities to actually take care of them in a comprehensive way in that
of them in a comprehensive way in that
of them in a comprehensive way in that kind of an atmosphere this is a biggest
kind of an atmosphere this is a biggest
kind of an atmosphere this is a biggest public enemy it’s not nuclear weapons
public enemy it’s not nuclear weapons
public enemy it’s not nuclear weapons it’s not missiles it’s not North Korea
it’s not missiles it’s not North Korea
it’s not missiles it’s not North Korea the humble mosquito kills more people
the humble mosquito kills more people
the humble mosquito kills more people than we can think of and we have not yet
than we can think of and we have not yet
than we can think of and we have not yet conquered this in this kind of a setting
conquered this in this kind of a setting
conquered this in this kind of a setting especially in a tropical country like
especially in a tropical country like
especially in a tropical country like ours you have to figure out how can I
ours you have to figure out how can I
ours you have to figure out how can I provide critical care for everybody all
provide critical care for everybody all
provide critical care for everybody all the time everywhere with these kinds of
the time everywhere with these kinds of
the time everywhere with these kinds of almost insurmountable challenges what
almost insurmountable challenges what
almost insurmountable challenges what can actually be done now anybody guess
can actually be done now anybody guess
can actually be done now anybody guess what planet that is it’s not Neptune it
what planet that is it’s not Neptune it
what planet that is it’s not Neptune it is a sometimes you have to look at your
is a sometimes you have to look at your
is a sometimes you have to look at your own planet little differently they’re
own planet little differently they’re
own planet little differently they’re not all water obviously there’s a lot of
not all water obviously there’s a lot of
not all water obviously there’s a lot of land on our planet but sometimes have to
land on our planet but sometimes have to
land on our planet but sometimes have to look at life differently so what we
look at life differently so what we
look at life differently so what we decided to do was can we approach this
decided to do was can we approach this
decided to do was can we approach this problem of extreme cost extremely sick
problem of extreme cost extremely sick
problem of extreme cost extremely sick patient lots of patients how can we look
patient lots of patients how can we look
patient lots of patients how can we look at it differently and figure out can we
at it differently and figure out can we
at it differently and figure out can we solve the problem during this thought
solve the problem during this thought
solve the problem during this thought process I came across a group overseas
process I came across a group overseas
process I came across a group overseas who are actually providing intensive
who are actually providing intensive
who are actually providing intensive care to
care to
care to in the united states located from abroad
in the united states located from abroad
in the united states located from abroad they were actually remotely monitoring
they were actually remotely monitoring
they were actually remotely monitoring patients in intensive care units around
patients in intensive care units around
patients in intensive care units around the United States and that concept was
the United States and that concept was
the United States and that concept was something that I was very attracted to I
something that I was very attracted to I
something that I was very attracted to I contacted them and in fact over about a
contacted them and in fact over about a
contacted them and in fact over about a period of a year or so started
period of a year or so started
period of a year or so started monitoring patients from India for the
monitoring patients from India for the
monitoring patients from India for the United States I have been doing that for
United States I have been doing that for
United States I have been doing that for about seven years now and during this
about seven years now and during this
about seven years now and during this process I thought struck me when I can
process I thought struck me when I can
process I thought struck me when I can sit here in Hyderabad and watch patients
sit here in Hyderabad and watch patients
sit here in Hyderabad and watch patients 8000 miles away why can’t I do it for
8000 miles away why can’t I do it for
8000 miles away why can’t I do it for India with this thought in mind they
India with this thought in mind they
India with this thought in mind they approached the people who run our
approached the people who run our
approached the people who run our hospital system and several other groups
hospital system and several other groups
hospital system and several other groups and we said let’s do this for India and
and we said let’s do this for India and
and we said let’s do this for India and we decided to begin a similar process
we decided to begin a similar process
we decided to begin a similar process where we actually watch patients
where we actually watch patients
where we actually watch patients remotely around India and other
remotely around India and other
remotely around India and other countries – they can actually provide
countries – they can actually provide
countries – they can actually provide critical care now in critical illness if
critical care now in critical illness if
critical care now in critical illness if you look at that slide there between
you look at that slide there between
you look at that slide there between health and critical illness there’s a
health and critical illness there’s a
health and critical illness there’s a transition you have to look at the group
transition you have to look at the group
transition you have to look at the group like somebody who’s sick you need to
like somebody who’s sick you need to
like somebody who’s sick you need to have someone first of all diagnose that
have someone first of all diagnose that
have someone first of all diagnose that they’re sick so you need an expert but
they’re sick so you need an expert but
they’re sick so you need an expert but the expert needs some evidence and some
the expert needs some evidence and some
the expert needs some evidence and some information data to conclude that this
information data to conclude that this
information data to conclude that this patient is sick and on top of all that
patient is sick and on top of all that
patient is sick and on top of all that you’re going to need to communicate
you’re going to need to communicate
you’re going to need to communicate between the patient the family the
between the patient the family the
between the patient the family the health system the labs etc to come up
health system the labs etc to come up
health system the labs etc to come up with a comprehensive plan on how to
with a comprehensive plan on how to
with a comprehensive plan on how to actually take care of this patient now
actually take care of this patient now
actually take care of this patient now the critical part of healthcare is the
the critical part of healthcare is the
the critical part of healthcare is the knowledge it is not the technology the
knowledge it is not the technology the
knowledge it is not the technology the knowledge is what really makes a
knowledge is what really makes a
knowledge is what really makes a difference between somebody who can take
difference between somebody who can take
difference between somebody who can take care of a patient and who cannot take
care of a patient and who cannot take
care of a patient and who cannot take care of a patient technology is critical
care of a patient technology is critical
care of a patient technology is critical but it is not the most critical part of
but it is not the most critical part of
but it is not the most critical part of taking care of an patient we have safety
taking care of an patient we have safety
taking care of an patient we have safety in the air why not on the ground several
in the air why not on the ground several
in the air why not on the ground several of you have flown in airplanes in the
of you have flown in airplanes in the
of you have flown in airplanes in the recent past you didn’t know the pilot
recent past you didn’t know the pilot
recent past you didn’t know the pilot the pilot didn’t know you the air
the pilot didn’t know you the air
the pilot didn’t know you the air traffic controller controlling the
traffic controller controlling the
traffic controller controlling the aircraft had no clue who the pilot was
aircraft had no clue who the pilot was
aircraft had no clue who the pilot was but you took off safely and you landed
but you took off safely and you landed
but you took off safely and you landed safely why can’t we do that in health
safely why can’t we do that in health
safely why can’t we do that in health care in fact we should be doing
care in fact we should be doing
care in fact we should be doing something even more aggressive in health
something even more aggressive in health
something even more aggressive in health care because lives are at stake if we
care because lives are at stake if we
care because lives are at stake if we can replicate what the aviation industry
can replicate what the aviation industry
can replicate what the aviation industry can do
can do
can do in terms of safety we will be able to
in terms of safety we will be able to
in terms of safety we will be able to achieve significant advances in taking
achieve significant advances in taking
achieve significant advances in taking care of especially critically ill
care of especially critically ill
care of especially critically ill patients the centerpiece over there is
patients the centerpiece over there is
patients the centerpiece over there is Narada I call him the ideal god of
Narada I call him the ideal god of
Narada I call him the ideal god of communication
communication
communication he’s obviously mythology says he’s
he’s obviously mythology says he’s
he’s obviously mythology says he’s talking among the world’s communicating
talking among the world’s communicating
talking among the world’s communicating between different people
between different people
between different people Health Care’s like that if you want to
Health Care’s like that if you want to
Health Care’s like that if you want to be a good healthcare provider
be a good healthcare provider
be a good healthcare provider communication is key there is extremely
communication is key there is extremely
communication is key there is extremely good data to show that if you
good data to show that if you
good data to show that if you communicate well you have less errors
communicate well you have less errors
communicate well you have less errors you actually improve the outcomes there
you actually improve the outcomes there
you actually improve the outcomes there are less people dying you can actually
are less people dying you can actually
are less people dying you can actually lower the cost and definitely improve
lower the cost and definitely improve
lower the cost and definitely improve healthcare so I think Narada is a good
healthcare so I think Narada is a good
healthcare so I think Narada is a good example of how to really be an effective
example of how to really be an effective
example of how to really be an effective healthcare provider and tele ICU which
healthcare provider and tele ICU which
healthcare provider and tele ICU which is a concept I’m talking about is
is a concept I’m talking about is
is a concept I’m talking about is remotely providing intensive care to
remotely providing intensive care to
remotely providing intensive care to patients wherever they may be using
patients wherever they may be using
patients wherever they may be using technology now that’s doctor scribble
technology now that’s doctor scribble
technology now that’s doctor scribble now obviously this is still a typical of
now obviously this is still a typical of
now obviously this is still a typical of my handwriting but I call this the cliff
my handwriting but I call this the cliff
my handwriting but I call this the cliff theory I don’t know if you make out but
theory I don’t know if you make out but
theory I don’t know if you make out but write the black stuff is the cliff at
write the black stuff is the cliff at
write the black stuff is the cliff at the left bottom is a patient in a bed he
the left bottom is a patient in a bed he
the left bottom is a patient in a bed he fell off the cliff
fell off the cliff
fell off the cliff Health Care’s like that patients are
Health Care’s like that patients are
Health Care’s like that patients are falling off the cliff illness is pushing
falling off the cliff illness is pushing
falling off the cliff illness is pushing them off the cliff and the healthcare
them off the cliff and the healthcare
them off the cliff and the healthcare teams role is to pull them back up onto
teams role is to pull them back up onto
teams role is to pull them back up onto the top of the cliff and as far away
the top of the cliff and as far away
the top of the cliff and as far away from the edge as possible
from the edge as possible
from the edge as possible now that’s an expensive proposition if
now that’s an expensive proposition if
now that’s an expensive proposition if you have a patient – it’s several
you have a patient – it’s several
you have a patient – it’s several illnesses it’s going to be hard to keep
illnesses it’s going to be hard to keep
illnesses it’s going to be hard to keep pulling but several patients are so sick
pulling but several patients are so sick
pulling but several patients are so sick that they keep falling down sometimes
that they keep falling down sometimes
that they keep falling down sometimes it’s not their fault sometimes it’s
it’s not their fault sometimes it’s
it’s not their fault sometimes it’s their fault a smoker someone who drinks
their fault a smoker someone who drinks
their fault a smoker someone who drinks a lot someone who doesn’t take their
a lot someone who doesn’t take their
a lot someone who doesn’t take their diabetic medications they will keep
diabetic medications they will keep
diabetic medications they will keep falling off the cliff now one of the big
falling off the cliff now one of the big
falling off the cliff now one of the big reasons for healthcare costs is the
reasons for healthcare costs is the
reasons for healthcare costs is the cliff and what I would propose is that
cliff and what I would propose is that
cliff and what I would propose is that you can actually guide people back up to
you can actually guide people back up to
you can actually guide people back up to climb up and get back onto a healthy
climb up and get back onto a healthy
climb up and get back onto a healthy atmosphere if you actually use
atmosphere if you actually use
atmosphere if you actually use technology with expert advice
technology with expert advice
technology with expert advice another homemade video let’s see that
another homemade video let’s see that
another homemade video let’s see that works
well I was supposed to be called sighs
well I was supposed to be called sighs orange try that Newton’s apple so you
orange try that Newton’s apple so you
orange try that Newton’s apple so you would have seen a slow-motion video of
would have seen a slow-motion video of
would have seen a slow-motion video of an orange coming up and down the reason
an orange coming up and down the reason
an orange coming up and down the reason I put that up is when you talk about
I put that up is when you talk about
I put that up is when you talk about Newton’s apple you think of physics it’s
Newton’s apple you think of physics it’s
Newton’s apple you think of physics it’s ER we’ll be talking about later you
ER we’ll be talking about later you
ER we’ll be talking about later you think about physics but really the Apple
think about physics but really the Apple
think about physics but really the Apple is an epitome of biology the Apple is
is an epitome of biology the Apple is
is an epitome of biology the Apple is also an epitome of genetics the Apple
also an epitome of genetics the Apple
also an epitome of genetics the Apple talks about mathematics with its shape
talks about mathematics with its shape
talks about mathematics with its shape likewise in healthcare we really need to
likewise in healthcare we really need to
likewise in healthcare we really need to have an interdisciplinary approach
have an interdisciplinary approach
have an interdisciplinary approach doctors cannot be in isolation when
doctors cannot be in isolation when
doctors cannot be in isolation when they’re actually taking care of patients
they’re actually taking care of patients
they’re actually taking care of patients you really have to think about what else
you really have to think about what else
you really have to think about what else can I use to help patients and often
can I use to help patients and often
can I use to help patients and often times it’s not the health guy it’s not
times it’s not the health guy it’s not
times it’s not the health guy it’s not the medicine it’s not the surgical tools
the medicine it’s not the surgical tools
the medicine it’s not the surgical tools it’s more about what can I bring
it’s more about what can I bring
it’s more about what can I bring together to help a patient make pushpa
together to help a patient make pushpa
together to help a patient make pushpa push fires on the Outer Ring Road 100
push fires on the Outer Ring Road 100
push fires on the Outer Ring Road 100 kilometers from nearest hospital what
kilometers from nearest hospital what
kilometers from nearest hospital what can I give her to save her life what if
can I give her to save her life what if
can I give her to save her life what if the car that she was in had a first-aid
the car that she was in had a first-aid
the car that she was in had a first-aid kit with a defibrillator what if there
kit with a defibrillator what if there
kit with a defibrillator what if there was good cell phone coverage where I
was good cell phone coverage where I
was good cell phone coverage where I could FaceTime with her and tell her you
could FaceTime with her and tell her you
could FaceTime with her and tell her you know what put the leads on the patient
know what put the leads on the patient
know what put the leads on the patient and see if she’s in ventricular
and see if she’s in ventricular
and see if she’s in ventricular fibrillation
fibrillation
fibrillation and press the button to cave electric
and press the button to cave electric
and press the button to cave electric energy to revive the heart these are
energy to revive the heart these are
energy to revive the heart these are things which are completely doable now
things which are completely doable now
things which are completely doable now when you can do whatsapp we can you know
when you can do whatsapp we can you know
when you can do whatsapp we can you know transfer millions of rupees and dollars
transfer millions of rupees and dollars
transfer millions of rupees and dollars with the touch of a phone why not with
with the touch of a phone why not with
with the touch of a phone why not with healthcare this is a quick snapshot of
healthcare this is a quick snapshot of
healthcare this is a quick snapshot of what we do at one of our locations where
what we do at one of our locations where
what we do at one of our locations where you can see a picture of a nurse a
you can see a picture of a nurse a
you can see a picture of a nurse a doctor in the background we have a video
doctor in the background we have a video
doctor in the background we have a video screen where we are having continuous
screen where we are having continuous
screen where we are having continuous communication with remotely located
communication with remotely located
communication with remotely located intensive care units which are several
intensive care units which are several
intensive care units which are several hundred to thousands of kilometers away
hundred to thousands of kilometers away
hundred to thousands of kilometers away they’re able to talk to the patient we
they’re able to talk to the patient we
they’re able to talk to the patient we can see their ventilator we can actually
can see their ventilator we can actually
can see their ventilator we can actually look at their cardiac rhythm we have all
look at their cardiac rhythm we have all
look at their cardiac rhythm we have all the data in hand all we need at the
the data in hand all we need at the
the data in hand all we need at the other end is a relatively reasonably
other end is a relatively reasonably
other end is a relatively reasonably educated junior doctor who can carry out
educated junior doctor who can carry out
educated junior doctor who can carry out our instructions because that’s all you
our instructions because that’s all you
our instructions because that’s all you really need and this is not a new
really need and this is not a new
really need and this is not a new concept hundreds of years maybe decades
concept hundreds of years maybe decades
concept hundreds of years maybe decades doctors have been picking up the phone
doctors have been picking up the phone
doctors have been picking up the phone and giving advice
and giving advice
and giving advice the middle of the night the senior
the middle of the night the senior
the middle of the night the senior doctor is not coming into the hospital
doctor is not coming into the hospital
doctor is not coming into the hospital he’s telling that junior doctor what to
he’s telling that junior doctor what to
he’s telling that junior doctor what to do but this is way ahead of that where
do but this is way ahead of that where
do but this is way ahead of that where he can see the patient 24 by 7 with
he can see the patient 24 by 7 with
he can see the patient 24 by 7 with trained physicians actually evaluating
trained physicians actually evaluating
trained physicians actually evaluating and taking care of the patient remotely
and taking care of the patient remotely
and taking care of the patient remotely I have personally resuscitated patients
I have personally resuscitated patients
I have personally resuscitated patients 8,000 miles away I’ve instructed nurses
8,000 miles away I’ve instructed nurses
8,000 miles away I’ve instructed nurses to give medicines 8,000 miles away to
to give medicines 8,000 miles away to
to give medicines 8,000 miles away to get somebody back to life when we can
get somebody back to life when we can
get somebody back to life when we can actually effect such change using
actually effect such change using
actually effect such change using technology it really should be much more
technology it really should be much more
technology it really should be much more widespread this is a quick snapshot of
widespread this is a quick snapshot of
widespread this is a quick snapshot of what it looks like when we look at our
what it looks like when we look at our
what it looks like when we look at our screen we look at the cardiac rhythm we
screen we look at the cardiac rhythm we
screen we look at the cardiac rhythm we can have blacked out some of the data
can have blacked out some of the data
can have blacked out some of the data but you can actually peer in as good as
but you can actually peer in as good as
but you can actually peer in as good as the iris of the eye and see if there is
the iris of the eye and see if there is
the iris of the eye and see if there is a reaction or not I think tele ICU is
a reaction or not I think tele ICU is
a reaction or not I think tele ICU is here to stay you require nursing skills
here to stay you require nursing skills
here to stay you require nursing skills you require education of doctors you
you require education of doctors you
you require education of doctors you require structured evaluation you
require structured evaluation you
require structured evaluation you require essentially several components
require essentially several components
require essentially several components which will help you run a good system in
which will help you run a good system in
which will help you run a good system in place and a picture you see in the back
place and a picture you see in the back
place and a picture you see in the back is the number of education classes
is the number of education classes
is the number of education classes you’ve been taking for people around the
you’ve been taking for people around the
you’ve been taking for people around the country so we physically go there and
country so we physically go there and
country so we physically go there and talk to the people in the different
talk to the people in the different
talk to the people in the different hospitals we are remotely teaching them
hospitals we are remotely teaching them
hospitals we are remotely teaching them every day and we are doing point of care
every day and we are doing point of care
every day and we are doing point of care education where we can tell them at 2:00
education where we can tell them at 2:00
education where we can tell them at 2:00 in the morning you know that’s not the
in the morning you know that’s not the
in the morning you know that’s not the way you do it you do it the other way
way you do it you do it the other way
way you do it you do it the other way and we can actually improve healthcare
and we can actually improve healthcare
and we can actually improve healthcare in the hope is that the care at the
in the hope is that the care at the
in the hope is that the care at the remote sites improves so much that you
remote sites improves so much that you
remote sites improves so much that you actually don’t require us my goal is in
actually don’t require us my goal is in
actually don’t require us my goal is in five years you don’t need us because you
five years you don’t need us because you
five years you don’t need us because you either becomes so good that you’re
either becomes so good that you’re
either becomes so good that you’re attracting talent and people want to
attracting talent and people want to
attracting talent and people want to stay in your remote areas and you
stay in your remote areas and you
stay in your remote areas and you actually want the doctors don’t want to
actually want the doctors don’t want to
actually want the doctors don’t want to leave and there are some elements
leave and there are some elements
leave and there are some elements pointing in that direction especially in
pointing in that direction especially in
pointing in that direction especially in rural areas the United States where
rural areas the United States where
rural areas the United States where they’re seeing that nurses and doctors
they’re seeing that nurses and doctors
they’re seeing that nurses and doctors have significant job satisfaction when
have significant job satisfaction when
have significant job satisfaction when they know there is a element of support
they know there is a element of support
they know there is a element of support of course there are challenges there are
of course there are challenges there are
of course there are challenges there are mountains to be climb there are clouds
mountains to be climb there are clouds
mountains to be climb there are clouds to be parted apart where nothing works
to be parted apart where nothing works
to be parted apart where nothing works completely as you want it to be you can
completely as you want it to be you can
completely as you want it to be you can be a technological challenge it can be a
be a technological challenge it can be a
be a technological challenge it can be a bandwidth challenge but the biggest
bandwidth challenge but the biggest
bandwidth challenge but the biggest challenge probably is a challenge of the
challenge probably is a challenge of the
challenge probably is a challenge of the concept
concept
concept it would be almost preposterous to think
it would be almost preposterous to think
it would be almost preposterous to think of me saying that I can sit here right
of me saying that I can sit here right
of me saying that I can sit here right now and on my telephone pull up an
now and on my telephone pull up an
now and on my telephone pull up an intensive care unit 10,000 kilometers
intensive care unit 10,000 kilometers
intensive care unit 10,000 kilometers away and talk to somebody and tell them
away and talk to somebody and tell them
away and talk to somebody and tell them you know you need to increase the dose
you know you need to increase the dose
you know you need to increase the dose of that medication but that’s the
of that medication but that’s the
of that medication but that’s the reality I could actually do that if I
reality I could actually do that if I
reality I could actually do that if I wanted to but there are several barriers
wanted to but there are several barriers
wanted to but there are several barriers to doing that right away because you
to doing that right away because you
to doing that right away because you have regulatory barriers your barriers
have regulatory barriers your barriers
have regulatory barriers your barriers of Education you need to have an
of Education you need to have an
of Education you need to have an established link with a entity so there
established link with a entity so there
established link with a entity so there are several logistic issues which are
are several logistic issues which are
are several logistic issues which are actually the bigger challenges to
actually the bigger challenges to
actually the bigger challenges to running something like this that’s a sad
running something like this that’s a sad
running something like this that’s a sad slide I’ll tell you why it’s sad we did
slide I’ll tell you why it’s sad we did
slide I’ll tell you why it’s sad we did an analysis of what kind of patients are
an analysis of what kind of patients are
an analysis of what kind of patients are we seeing as expected there was a lot of
we seeing as expected there was a lot of
we seeing as expected there was a lot of heart disease there was a lot of lung
heart disease there was a lot of lung
heart disease there was a lot of lung disease and an assortment of other
disease and an assortment of other
disease and an assortment of other diseases but almost catching up with
diseases but almost catching up with
diseases but almost catching up with heart and lung disease was a number of
heart and lung disease was a number of
heart and lung disease was a number of people trying to kill themselves
people trying to kill themselves
people trying to kill themselves organophosphate poisoning or pesticide
organophosphate poisoning or pesticide
organophosphate poisoning or pesticide poisoning almost caught up with a number
poisoning almost caught up with a number
poisoning almost caught up with a number of people with heart or lung problems
of people with heart or lung problems
of people with heart or lung problems critical care is not a health care issue
critical care is not a health care issue
critical care is not a health care issue it’s a social issue this is a social
it’s a social issue this is a social
it’s a social issue this is a social issue
issue
issue until we fix the poor farmer out there
until we fix the poor farmer out there
until we fix the poor farmer out there who doesn’t have enough to eat who is
who doesn’t have enough to eat who is
who doesn’t have enough to eat who is forced to actually think about taking
forced to actually think about taking
forced to actually think about taking his own life none of this matters it
his own life none of this matters it
his own life none of this matters it doesn’t matter if we build buildings of
doesn’t matter if we build buildings of
doesn’t matter if we build buildings of 100 stories high it doesn’t matter if
100 stories high it doesn’t matter if
100 stories high it doesn’t matter if you have airplanes which go 4 times
you have airplanes which go 4 times
you have airplanes which go 4 times speed of sound until we can affect that
speed of sound until we can affect that
speed of sound until we can affect that one individual out there who is right
one individual out there who is right
one individual out there who is right now right now sitting out there in
now right now sitting out there in
now right now sitting out there in contemplating you know life is not worth
contemplating you know life is not worth
contemplating you know life is not worth it until we can actually make a change
it until we can actually make a change
it until we can actually make a change there none of this matters some of the
there none of this matters some of the
there none of this matters some of the challenges technology is obviously going
challenges technology is obviously going
challenges technology is obviously going at jet speed things are going ahead
at jet speed things are going ahead
at jet speed things are going ahead healthcare applications healthcare
healthcare applications healthcare
healthcare applications healthcare procedures are going ahead at the pace
procedures are going ahead at the pace
procedures are going ahead at the pace of a running man the one thing that
of a running man the one thing that
of a running man the one thing that isn’t changing fast enough is doctors
isn’t changing fast enough is doctors
isn’t changing fast enough is doctors and health care’s adoption of these
and health care’s adoption of these
and health care’s adoption of these changes there’s an intrinsic in
changes there’s an intrinsic in
changes there’s an intrinsic in which I call you can’t see it well bits
which I call you can’t see it well bits
which I call you can’t see it well bits like a snail and some of the speed
like a snail and some of the speed
like a snail and some of the speed blocks are doctors themselves we are
blocks are doctors themselves we are
blocks are doctors themselves we are somewhat slow to adapt these things
somewhat slow to adapt these things
somewhat slow to adapt these things sometimes a good measure because you get
sometimes a good measure because you get
sometimes a good measure because you get this new concept it changes overnight
this new concept it changes overnight
this new concept it changes overnight and you think it’s not right anymore but
and you think it’s not right anymore but
and you think it’s not right anymore but sometimes they have to figure out can we
sometimes they have to figure out can we
sometimes they have to figure out can we actually affect change by integrating
actually affect change by integrating
actually affect change by integrating assimilating and collaborating with
assimilating and collaborating with
assimilating and collaborating with several other people
several other people
several other people I think this quotation I like to
I think this quotation I like to
I think this quotation I like to sometimes say because it’s very
sometimes say because it’s very
sometimes say because it’s very inspiring and optimistic quotation for
inspiring and optimistic quotation for
inspiring and optimistic quotation for me we really think the past is history
me we really think the past is history
me we really think the past is history the future is a mystery today is a gift
the future is a mystery today is a gift
the future is a mystery today is a gift and that is why we call it the present
and that is why we call it the present
and that is why we call it the present and and oppositely like this for me to
and and oppositely like this for me to
and and oppositely like this for me to share with all of you what I do where I
share with all of you what I do where I
share with all of you what I do where I can actually deliver intensive care to
can actually deliver intensive care to
can actually deliver intensive care to people who have not able to even touch
people who have not able to even touch
people who have not able to even touch who are far away but I can actually
who are far away but I can actually
who are far away but I can actually impact their lives this is a great
impact their lives this is a great
impact their lives this is a great beginning and a great opportunity and I
beginning and a great opportunity and I
beginning and a great opportunity and I think one of the reasons we’re all here
think one of the reasons we’re all here
think one of the reasons we’re all here because you never stop learning because
because you never stop learning because
because you never stop learning because life never stops teaching and I showed
life never stops teaching and I showed
life never stops teaching and I showed this slide to my son and he said but Dad
this slide to my son and he said but Dad
this slide to my son and he said but Dad you got to use what you learned so
you got to use what you learned so
you got to use what you learned so exactly so I think what we really need
exactly so I think what we really need
exactly so I think what we really need to figure out is can we actually make a
to figure out is can we actually make a
to figure out is can we actually make a change and affect change by simple
change and affect change by simple
change and affect change by simple things we keep our eyes open and help
things we keep our eyes open and help
things we keep our eyes open and help Pushpa
Pushpa
Pushpa Pushpa could be anywhere she might be in
Pushpa could be anywhere she might be in
Pushpa could be anywhere she might be in Dubai she might be in America she might
Dubai she might be in America she might
Dubai she might be in America she might be in India I think until we actually
be in India I think until we actually
be in India I think until we actually figure out can we make a change where we
figure out can we make a change where we
figure out can we make a change where we integrate our knowledge with technology
integrate our knowledge with technology
integrate our knowledge with technology and an intention to serve we will only
and an intention to serve we will only
and an intention to serve we will only then make a difference thank you
you [Music]
life as we know is unpredictable we know
life as we know is unpredictable we know life is very unpredictable we know today
life is very unpredictable we know today
life is very unpredictable we know today life is unpredictable and as a physician
life is unpredictable and as a physician
life is unpredictable and as a physician and a doctor who does pulmonary and
and a doctor who does pulmonary and
and a doctor who does pulmonary and critical care I’m the kind of doctor you
critical care I’m the kind of doctor you
critical care I’m the kind of doctor you don’t want to see you have to be really
don’t want to see you have to be really
don’t want to see you have to be really sick to come see me what I do is I take
sick to come see me what I do is I take
sick to come see me what I do is I take care of patients who have very severe
care of patients who have very severe
care of patients who have very severe illnesses and I’m actually helping them
illnesses and I’m actually helping them
illnesses and I’m actually helping them get back to life a lot of times and
get back to life a lot of times and
get back to life a lot of times and critical illness their vital signs are
critical illness their vital signs are
critical illness their vital signs are abnormal their heart rates lower fast
abnormal their heart rates lower fast
abnormal their heart rates lower fast their blood pressures lower extremely
their blood pressures lower extremely
their blood pressures lower extremely high and people are really dying and in
high and people are really dying and in
high and people are really dying and in this kind of a setting if you can
this kind of a setting if you can
this kind of a setting if you can provide critical care which is really
provide critical care which is really
provide critical care which is really providing support vital support to
providing support vital support to
providing support vital support to patients at the critical phase of their
patients at the critical phase of their
patients at the critical phase of their life you can make a difference when you
life you can make a difference when you
life you can make a difference when you can provide critical care you really
can provide critical care you really
can provide critical care you really need a hospital you need a machine you
need a hospital you need a machine you
need a hospital you need a machine you need high tech monitors but the truth is
need high tech monitors but the truth is
need high tech monitors but the truth is that isn’t the truth you really need
that isn’t the truth you really need
that isn’t the truth you really need expertise to be shared and today I’m
expertise to be shared and today I’m
expertise to be shared and today I’m going to share with you an overview of
going to share with you an overview of
going to share with you an overview of what that can be because you can
what that can be because you can
what that can be because you can actually provide intensive care
actually provide intensive care
actually provide intensive care everywhere to anybody anytime let’s take
everywhere to anybody anytime let’s take
everywhere to anybody anytime let’s take the case of mrs. Pushpa she’s about 50
the case of mrs. Pushpa she’s about 50
the case of mrs. Pushpa she’s about 50 years old she had heard about chest pain
years old she had heard about chest pain
years old she had heard about chest pain for last 30 minutes she’s been quite
for last 30 minutes she’s been quite
for last 30 minutes she’s been quite short of breath has not been able to
short of breath has not been able to
short of breath has not been able to catch her breath she’s had difficulty in
catch her breath she’s had difficulty in
catch her breath she’s had difficulty in walking and then she complains to her
walking and then she complains to her
walking and then she complains to her people nearby saying I’m not able to
people nearby saying I’m not able to
people nearby saying I’m not able to breathe what can I do they immediately
breathe what can I do they immediately
breathe what can I do they immediately rush her to the nearest hospital she has
rush her to the nearest hospital she has
rush her to the nearest hospital she has a low blood pressure and then they
a low blood pressure and then they
a low blood pressure and then they realize that you know she needs to be
realize that you know she needs to be
realize that you know she needs to be treated for possibly a heart attack now
treated for possibly a heart attack now
treated for possibly a heart attack now the question that the doctor at that
the question that the doctor at that
the question that the doctor at that location faces is can we actually keep
location faces is can we actually keep
location faces is can we actually keep the patient here should we move the
the patient here should we move the
the patient here should we move the patient what can we do and that depends
patient what can we do and that depends
patient what can we do and that depends on the expertise of the hospital the
on the expertise of the hospital the
on the expertise of the hospital the doctor and how sick the patient is that
doctor and how sick the patient is that
doctor and how sick the patient is that could be in New York City
could be in New York City
could be in New York City Pushpa might be there she might be in
Pushpa might be there she might be in
Pushpa might be there she might be in Jubilee Hills or she might be on the
Jubilee Hills or she might be on the
Jubilee Hills or she might be on the Outer Ring Road going in a car 100
Outer Ring Road going in a car 100
Outer Ring Road going in a car 100 kilometers from the nearest hospital
kilometers from the nearest hospital
kilometers from the nearest hospital what can we do in that setting when you
what can we do in that setting when you
what can we do in that setting when you are facing a situation like that you
are facing a situation like that you
are facing a situation like that you come
come
come across critical-care unfortunately not
across critical-care unfortunately not
across critical-care unfortunately not just an India but around the world the
just an India but around the world the
just an India but around the world the cost of critical care is unreasonable
cost of critical care is unreasonable
cost of critical care is unreasonable the average cost is about 17 thousand
the average cost is about 17 thousand
the average cost is about 17 thousand rupees on average it shoots up all the
rupees on average it shoots up all the
rupees on average it shoots up all the way up to the several lakhs to the
way up to the several lakhs to the
way up to the several lakhs to the crores if somebody is extremely ill now
crores if somebody is extremely ill now
crores if somebody is extremely ill now this is the reality that Pushpa might
this is the reality that Pushpa might
this is the reality that Pushpa might have to face depending on where she’s
have to face depending on where she’s
have to face depending on where she’s from who she is and which hospital she’s
from who she is and which hospital she’s
from who she is and which hospital she’s in and also depends on how sick she is
in and also depends on how sick she is
in and also depends on how sick she is about 40% of people actually end up in
about 40% of people actually end up in
about 40% of people actually end up in poverty after one episode of illness
poverty after one episode of illness
poverty after one episode of illness where they have to borrow money and they
where they have to borrow money and they
where they have to borrow money and they have to actually change their complete
have to actually change their complete
have to actually change their complete lifestyle sell lands etc there’s a huge
lifestyle sell lands etc there’s a huge
lifestyle sell lands etc there’s a huge gap huge gap between the number of
gap huge gap between the number of
gap huge gap between the number of patients and the number of beds there’s
patients and the number of beds there’s
patients and the number of beds there’s only about 70,000 critical care beds in
only about 70,000 critical care beds in
only about 70,000 critical care beds in India for five million patients that’s a
India for five million patients that’s a
India for five million patients that’s a gigantic gap we clearly have lots of
gigantic gap we clearly have lots of
gigantic gap we clearly have lots of patients extremely sick patients not
patients extremely sick patients not
patients extremely sick patients not enough facilities to actually take care
enough facilities to actually take care
enough facilities to actually take care of them in a comprehensive way in that
of them in a comprehensive way in that
of them in a comprehensive way in that kind of an atmosphere this is a biggest
kind of an atmosphere this is a biggest
kind of an atmosphere this is a biggest public enemy it’s not nuclear weapons
public enemy it’s not nuclear weapons
public enemy it’s not nuclear weapons it’s not missiles it’s not North Korea
it’s not missiles it’s not North Korea
it’s not missiles it’s not North Korea the humble mosquito kills more people
the humble mosquito kills more people
the humble mosquito kills more people than we can think of and we have not yet
than we can think of and we have not yet
than we can think of and we have not yet conquered this in this kind of a setting
conquered this in this kind of a setting
conquered this in this kind of a setting especially in a tropical country like
especially in a tropical country like
especially in a tropical country like ours you have to figure out how can I
ours you have to figure out how can I
ours you have to figure out how can I provide critical care for everybody all
provide critical care for everybody all
provide critical care for everybody all the time everywhere with these kinds of
the time everywhere with these kinds of
the time everywhere with these kinds of almost insurmountable challenges what
almost insurmountable challenges what
almost insurmountable challenges what can actually be done now anybody guess
can actually be done now anybody guess
can actually be done now anybody guess what planet that is it’s not Neptune it
what planet that is it’s not Neptune it
what planet that is it’s not Neptune it is a sometimes you have to look at your
is a sometimes you have to look at your
is a sometimes you have to look at your own planet little differently they’re
own planet little differently they’re
own planet little differently they’re not all water obviously there’s a lot of
not all water obviously there’s a lot of
not all water obviously there’s a lot of land on our planet but sometimes have to
land on our planet but sometimes have to
land on our planet but sometimes have to look at life differently so what we
look at life differently so what we
look at life differently so what we decided to do was can we approach this
decided to do was can we approach this
decided to do was can we approach this problem of extreme cost extremely sick
problem of extreme cost extremely sick
problem of extreme cost extremely sick patient lots of patients how can we look
patient lots of patients how can we look
patient lots of patients how can we look at it differently and figure out can we
at it differently and figure out can we
at it differently and figure out can we solve the problem during this thought
solve the problem during this thought
solve the problem during this thought process I came across a group overseas
process I came across a group overseas
process I came across a group overseas who are actually providing intensive
who are actually providing intensive
who are actually providing intensive care to
care to
care to in the united states located from abroad
in the united states located from abroad
in the united states located from abroad they were actually remotely monitoring
they were actually remotely monitoring
they were actually remotely monitoring patients in intensive care units around
patients in intensive care units around
patients in intensive care units around the United States and that concept was
the United States and that concept was
the United States and that concept was something that I was very attracted to I
something that I was very attracted to I
something that I was very attracted to I contacted them and in fact over about a
contacted them and in fact over about a
contacted them and in fact over about a period of a year or so started
period of a year or so started
period of a year or so started monitoring patients from India for the
monitoring patients from India for the
monitoring patients from India for the United States I have been doing that for
United States I have been doing that for
United States I have been doing that for about seven years now and during this
about seven years now and during this
about seven years now and during this process I thought struck me when I can
process I thought struck me when I can
process I thought struck me when I can sit here in Hyderabad and watch patients
sit here in Hyderabad and watch patients
sit here in Hyderabad and watch patients 8000 miles away why can’t I do it for
8000 miles away why can’t I do it for
8000 miles away why can’t I do it for India with this thought in mind they
India with this thought in mind they
India with this thought in mind they approached the people who run our
approached the people who run our
approached the people who run our hospital system and several other groups
hospital system and several other groups
hospital system and several other groups and we said let’s do this for India and
and we said let’s do this for India and
and we said let’s do this for India and we decided to begin a similar process
we decided to begin a similar process
we decided to begin a similar process where we actually watch patients
where we actually watch patients
where we actually watch patients remotely around India and other
remotely around India and other
remotely around India and other countries – they can actually provide
countries – they can actually provide
countries – they can actually provide critical care now in critical illness if
critical care now in critical illness if
critical care now in critical illness if you look at that slide there between
you look at that slide there between
you look at that slide there between health and critical illness there’s a
health and critical illness there’s a
health and critical illness there’s a transition you have to look at the group
transition you have to look at the group
transition you have to look at the group like somebody who’s sick you need to
like somebody who’s sick you need to
like somebody who’s sick you need to have someone first of all diagnose that
have someone first of all diagnose that
have someone first of all diagnose that they’re sick so you need an expert but
they’re sick so you need an expert but
they’re sick so you need an expert but the expert needs some evidence and some
the expert needs some evidence and some
the expert needs some evidence and some information data to conclude that this
information data to conclude that this
information data to conclude that this patient is sick and on top of all that
patient is sick and on top of all that
patient is sick and on top of all that you’re going to need to communicate
you’re going to need to communicate
you’re going to need to communicate between the patient the family the
between the patient the family the
between the patient the family the health system the labs etc to come up
health system the labs etc to come up
health system the labs etc to come up with a comprehensive plan on how to
with a comprehensive plan on how to
with a comprehensive plan on how to actually take care of this patient now
actually take care of this patient now
actually take care of this patient now the critical part of healthcare is the
the critical part of healthcare is the
the critical part of healthcare is the knowledge it is not the technology the
knowledge it is not the technology the
knowledge it is not the technology the knowledge is what really makes a
knowledge is what really makes a
knowledge is what really makes a difference between somebody who can take
difference between somebody who can take
difference between somebody who can take care of a patient and who cannot take
care of a patient and who cannot take
care of a patient and who cannot take care of a patient technology is critical
care of a patient technology is critical
care of a patient technology is critical but it is not the most critical part of
but it is not the most critical part of
but it is not the most critical part of taking care of an patient we have safety
taking care of an patient we have safety
taking care of an patient we have safety in the air why not on the ground several
in the air why not on the ground several
in the air why not on the ground several of you have flown in airplanes in the
of you have flown in airplanes in the
of you have flown in airplanes in the recent past you didn’t know the pilot
recent past you didn’t know the pilot
recent past you didn’t know the pilot the pilot didn’t know you the air
the pilot didn’t know you the air
the pilot didn’t know you the air traffic controller controlling the
traffic controller controlling the
traffic controller controlling the aircraft had no clue who the pilot was
aircraft had no clue who the pilot was
aircraft had no clue who the pilot was but you took off safely and you landed
but you took off safely and you landed
but you took off safely and you landed safely why can’t we do that in health
safely why can’t we do that in health
safely why can’t we do that in health care in fact we should be doing
care in fact we should be doing
care in fact we should be doing something even more aggressive in health
something even more aggressive in health
something even more aggressive in health care because lives are at stake if we
care because lives are at stake if we
care because lives are at stake if we can replicate what the aviation industry
can replicate what the aviation industry
can replicate what the aviation industry can do
can do
can do in terms of safety we will be able to
in terms of safety we will be able to
in terms of safety we will be able to achieve significant advances in taking
achieve significant advances in taking
achieve significant advances in taking care of especially critically ill
care of especially critically ill
care of especially critically ill patients the centerpiece over there is
patients the centerpiece over there is
patients the centerpiece over there is Narada I call him the ideal god of
Narada I call him the ideal god of
Narada I call him the ideal god of communication
communication
communication he’s obviously mythology says he’s
he’s obviously mythology says he’s
he’s obviously mythology says he’s talking among the world’s communicating
talking among the world’s communicating
talking among the world’s communicating between different people
between different people
between different people Health Care’s like that if you want to
Health Care’s like that if you want to
Health Care’s like that if you want to be a good healthcare provider
be a good healthcare provider
be a good healthcare provider communication is key there is extremely
communication is key there is extremely
communication is key there is extremely good data to show that if you
good data to show that if you
good data to show that if you communicate well you have less errors
communicate well you have less errors
communicate well you have less errors you actually improve the outcomes there
you actually improve the outcomes there
you actually improve the outcomes there are less people dying you can actually
are less people dying you can actually
are less people dying you can actually lower the cost and definitely improve
lower the cost and definitely improve
lower the cost and definitely improve healthcare so I think Narada is a good
healthcare so I think Narada is a good
healthcare so I think Narada is a good example of how to really be an effective
example of how to really be an effective
example of how to really be an effective healthcare provider and tele ICU which
healthcare provider and tele ICU which
healthcare provider and tele ICU which is a concept I’m talking about is
is a concept I’m talking about is
is a concept I’m talking about is remotely providing intensive care to
remotely providing intensive care to
remotely providing intensive care to patients wherever they may be using
patients wherever they may be using
patients wherever they may be using technology now that’s doctor scribble
technology now that’s doctor scribble
technology now that’s doctor scribble now obviously this is still a typical of
now obviously this is still a typical of
now obviously this is still a typical of my handwriting but I call this the cliff
my handwriting but I call this the cliff
my handwriting but I call this the cliff theory I don’t know if you make out but
theory I don’t know if you make out but
theory I don’t know if you make out but write the black stuff is the cliff at
write the black stuff is the cliff at
write the black stuff is the cliff at the left bottom is a patient in a bed he
the left bottom is a patient in a bed he
the left bottom is a patient in a bed he fell off the cliff
fell off the cliff
fell off the cliff Health Care’s like that patients are
Health Care’s like that patients are
Health Care’s like that patients are falling off the cliff illness is pushing
falling off the cliff illness is pushing
falling off the cliff illness is pushing them off the cliff and the healthcare
them off the cliff and the healthcare
them off the cliff and the healthcare teams role is to pull them back up onto
teams role is to pull them back up onto
teams role is to pull them back up onto the top of the cliff and as far away
the top of the cliff and as far away
the top of the cliff and as far away from the edge as possible
from the edge as possible
from the edge as possible now that’s an expensive proposition if
now that’s an expensive proposition if
now that’s an expensive proposition if you have a patient – it’s several
you have a patient – it’s several
you have a patient – it’s several illnesses it’s going to be hard to keep
illnesses it’s going to be hard to keep
illnesses it’s going to be hard to keep pulling but several patients are so sick
pulling but several patients are so sick
pulling but several patients are so sick that they keep falling down sometimes
that they keep falling down sometimes
that they keep falling down sometimes it’s not their fault sometimes it’s
it’s not their fault sometimes it’s
it’s not their fault sometimes it’s their fault a smoker someone who drinks
their fault a smoker someone who drinks
their fault a smoker someone who drinks a lot someone who doesn’t take their
a lot someone who doesn’t take their
a lot someone who doesn’t take their diabetic medications they will keep
diabetic medications they will keep
diabetic medications they will keep falling off the cliff now one of the big
falling off the cliff now one of the big
falling off the cliff now one of the big reasons for healthcare costs is the
reasons for healthcare costs is the
reasons for healthcare costs is the cliff and what I would propose is that
cliff and what I would propose is that
cliff and what I would propose is that you can actually guide people back up to
you can actually guide people back up to
you can actually guide people back up to climb up and get back onto a healthy
climb up and get back onto a healthy
climb up and get back onto a healthy atmosphere if you actually use
atmosphere if you actually use
atmosphere if you actually use technology with expert advice
technology with expert advice
technology with expert advice another homemade video let’s see that
another homemade video let’s see that
another homemade video let’s see that works
well I was supposed to be called sighs
well I was supposed to be called sighs orange try that Newton’s apple so you
orange try that Newton’s apple so you
orange try that Newton’s apple so you would have seen a slow-motion video of
would have seen a slow-motion video of
would have seen a slow-motion video of an orange coming up and down the reason
an orange coming up and down the reason
an orange coming up and down the reason I put that up is when you talk about
I put that up is when you talk about
I put that up is when you talk about Newton’s apple you think of physics it’s
Newton’s apple you think of physics it’s
Newton’s apple you think of physics it’s ER we’ll be talking about later you
ER we’ll be talking about later you
ER we’ll be talking about later you think about physics but really the Apple
think about physics but really the Apple
think about physics but really the Apple is an epitome of biology the Apple is
is an epitome of biology the Apple is
is an epitome of biology the Apple is also an epitome of genetics the Apple
also an epitome of genetics the Apple
also an epitome of genetics the Apple talks about mathematics with its shape
talks about mathematics with its shape
talks about mathematics with its shape likewise in healthcare we really need to
likewise in healthcare we really need to
likewise in healthcare we really need to have an interdisciplinary approach
have an interdisciplinary approach
have an interdisciplinary approach doctors cannot be in isolation when
doctors cannot be in isolation when
doctors cannot be in isolation when they’re actually taking care of patients
they’re actually taking care of patients
they’re actually taking care of patients you really have to think about what else
you really have to think about what else
you really have to think about what else can I use to help patients and often
can I use to help patients and often
can I use to help patients and often times it’s not the health guy it’s not
times it’s not the health guy it’s not
times it’s not the health guy it’s not the medicine it’s not the surgical tools
the medicine it’s not the surgical tools
the medicine it’s not the surgical tools it’s more about what can I bring
it’s more about what can I bring
it’s more about what can I bring together to help a patient make pushpa
together to help a patient make pushpa
together to help a patient make pushpa push fires on the Outer Ring Road 100
push fires on the Outer Ring Road 100
push fires on the Outer Ring Road 100 kilometers from nearest hospital what
kilometers from nearest hospital what
kilometers from nearest hospital what can I give her to save her life what if
can I give her to save her life what if
can I give her to save her life what if the car that she was in had a first-aid
the car that she was in had a first-aid
the car that she was in had a first-aid kit with a defibrillator what if there
kit with a defibrillator what if there
kit with a defibrillator what if there was good cell phone coverage where I
was good cell phone coverage where I
was good cell phone coverage where I could FaceTime with her and tell her you
could FaceTime with her and tell her you
could FaceTime with her and tell her you know what put the leads on the patient
know what put the leads on the patient
know what put the leads on the patient and see if she’s in ventricular
and see if she’s in ventricular
and see if she’s in ventricular fibrillation
fibrillation
fibrillation and press the button to cave electric
and press the button to cave electric
and press the button to cave electric energy to revive the heart these are
energy to revive the heart these are
energy to revive the heart these are things which are completely doable now
things which are completely doable now
things which are completely doable now when you can do whatsapp we can you know
when you can do whatsapp we can you know
when you can do whatsapp we can you know transfer millions of rupees and dollars
transfer millions of rupees and dollars
transfer millions of rupees and dollars with the touch of a phone why not with
with the touch of a phone why not with
with the touch of a phone why not with healthcare this is a quick snapshot of
healthcare this is a quick snapshot of
healthcare this is a quick snapshot of what we do at one of our locations where
what we do at one of our locations where
what we do at one of our locations where you can see a picture of a nurse a
you can see a picture of a nurse a
you can see a picture of a nurse a doctor in the background we have a video
doctor in the background we have a video
doctor in the background we have a video screen where we are having continuous
screen where we are having continuous
screen where we are having continuous communication with remotely located
communication with remotely located
communication with remotely located intensive care units which are several
intensive care units which are several
intensive care units which are several hundred to thousands of kilometers away
hundred to thousands of kilometers away
hundred to thousands of kilometers away they’re able to talk to the patient we
they’re able to talk to the patient we
they’re able to talk to the patient we can see their ventilator we can actually
can see their ventilator we can actually
can see their ventilator we can actually look at their cardiac rhythm we have all
look at their cardiac rhythm we have all
look at their cardiac rhythm we have all the data in hand all we need at the
the data in hand all we need at the
the data in hand all we need at the other end is a relatively reasonably
other end is a relatively reasonably
other end is a relatively reasonably educated junior doctor who can carry out
educated junior doctor who can carry out
educated junior doctor who can carry out our instructions because that’s all you
our instructions because that’s all you
our instructions because that’s all you really need and this is not a new
really need and this is not a new
really need and this is not a new concept hundreds of years maybe decades
concept hundreds of years maybe decades
concept hundreds of years maybe decades doctors have been picking up the phone
doctors have been picking up the phone
doctors have been picking up the phone and giving advice
and giving advice
and giving advice the middle of the night the senior
the middle of the night the senior
the middle of the night the senior doctor is not coming into the hospital
doctor is not coming into the hospital
doctor is not coming into the hospital he’s telling that junior doctor what to
he’s telling that junior doctor what to
he’s telling that junior doctor what to do but this is way ahead of that where
do but this is way ahead of that where
do but this is way ahead of that where he can see the patient 24 by 7 with
he can see the patient 24 by 7 with
he can see the patient 24 by 7 with trained physicians actually evaluating
trained physicians actually evaluating
trained physicians actually evaluating and taking care of the patient remotely
and taking care of the patient remotely
and taking care of the patient remotely I have personally resuscitated patients
I have personally resuscitated patients
I have personally resuscitated patients 8,000 miles away I’ve instructed nurses
8,000 miles away I’ve instructed nurses
8,000 miles away I’ve instructed nurses to give medicines 8,000 miles away to
to give medicines 8,000 miles away to
to give medicines 8,000 miles away to get somebody back to life when we can
get somebody back to life when we can
get somebody back to life when we can actually effect such change using
actually effect such change using
actually effect such change using technology it really should be much more
technology it really should be much more
technology it really should be much more widespread this is a quick snapshot of
widespread this is a quick snapshot of
widespread this is a quick snapshot of what it looks like when we look at our
what it looks like when we look at our
what it looks like when we look at our screen we look at the cardiac rhythm we
screen we look at the cardiac rhythm we
screen we look at the cardiac rhythm we can have blacked out some of the data
can have blacked out some of the data
can have blacked out some of the data but you can actually peer in as good as
but you can actually peer in as good as
but you can actually peer in as good as the iris of the eye and see if there is
the iris of the eye and see if there is
the iris of the eye and see if there is a reaction or not I think tele ICU is
a reaction or not I think tele ICU is
a reaction or not I think tele ICU is here to stay you require nursing skills
here to stay you require nursing skills
here to stay you require nursing skills you require education of doctors you
you require education of doctors you
you require education of doctors you require structured evaluation you
require structured evaluation you
require structured evaluation you require essentially several components
require essentially several components
require essentially several components which will help you run a good system in
which will help you run a good system in
which will help you run a good system in place and a picture you see in the back
place and a picture you see in the back
place and a picture you see in the back is the number of education classes
is the number of education classes
is the number of education classes you’ve been taking for people around the
you’ve been taking for people around the
you’ve been taking for people around the country so we physically go there and
country so we physically go there and
country so we physically go there and talk to the people in the different
talk to the people in the different
talk to the people in the different hospitals we are remotely teaching them
hospitals we are remotely teaching them
hospitals we are remotely teaching them every day and we are doing point of care
every day and we are doing point of care
every day and we are doing point of care education where we can tell them at 2:00
education where we can tell them at 2:00
education where we can tell them at 2:00 in the morning you know that’s not the
in the morning you know that’s not the
in the morning you know that’s not the way you do it you do it the other way
way you do it you do it the other way
way you do it you do it the other way and we can actually improve healthcare
and we can actually improve healthcare
and we can actually improve healthcare in the hope is that the care at the
in the hope is that the care at the
in the hope is that the care at the remote sites improves so much that you
remote sites improves so much that you
remote sites improves so much that you actually don’t require us my goal is in
actually don’t require us my goal is in
actually don’t require us my goal is in five years you don’t need us because you
five years you don’t need us because you
five years you don’t need us because you either becomes so good that you’re
either becomes so good that you’re
either becomes so good that you’re attracting talent and people want to
attracting talent and people want to
attracting talent and people want to stay in your remote areas and you
stay in your remote areas and you
stay in your remote areas and you actually want the doctors don’t want to
actually want the doctors don’t want to
actually want the doctors don’t want to leave and there are some elements
leave and there are some elements
leave and there are some elements pointing in that direction especially in
pointing in that direction especially in
pointing in that direction especially in rural areas the United States where
rural areas the United States where
rural areas the United States where they’re seeing that nurses and doctors
they’re seeing that nurses and doctors
they’re seeing that nurses and doctors have significant job satisfaction when
have significant job satisfaction when
have significant job satisfaction when they know there is a element of support
they know there is a element of support
they know there is a element of support of course there are challenges there are
of course there are challenges there are
of course there are challenges there are mountains to be climb there are clouds
mountains to be climb there are clouds
mountains to be climb there are clouds to be parted apart where nothing works
to be parted apart where nothing works
to be parted apart where nothing works completely as you want it to be you can
completely as you want it to be you can
completely as you want it to be you can be a technological challenge it can be a
be a technological challenge it can be a
be a technological challenge it can be a bandwidth challenge but the biggest
bandwidth challenge but the biggest
bandwidth challenge but the biggest challenge probably is a challenge of the
challenge probably is a challenge of the
challenge probably is a challenge of the concept
concept
concept it would be almost preposterous to think
it would be almost preposterous to think
it would be almost preposterous to think of me saying that I can sit here right
of me saying that I can sit here right
of me saying that I can sit here right now and on my telephone pull up an
now and on my telephone pull up an
now and on my telephone pull up an intensive care unit 10,000 kilometers
intensive care unit 10,000 kilometers
intensive care unit 10,000 kilometers away and talk to somebody and tell them
away and talk to somebody and tell them
away and talk to somebody and tell them you know you need to increase the dose
you know you need to increase the dose
you know you need to increase the dose of that medication but that’s the
of that medication but that’s the
of that medication but that’s the reality I could actually do that if I
reality I could actually do that if I
reality I could actually do that if I wanted to but there are several barriers
wanted to but there are several barriers
wanted to but there are several barriers to doing that right away because you
to doing that right away because you
to doing that right away because you have regulatory barriers your barriers
have regulatory barriers your barriers
have regulatory barriers your barriers of Education you need to have an
of Education you need to have an
of Education you need to have an established link with a entity so there
established link with a entity so there
established link with a entity so there are several logistic issues which are
are several logistic issues which are
are several logistic issues which are actually the bigger challenges to
actually the bigger challenges to
actually the bigger challenges to running something like this that’s a sad
running something like this that’s a sad
running something like this that’s a sad slide I’ll tell you why it’s sad we did
slide I’ll tell you why it’s sad we did
slide I’ll tell you why it’s sad we did an analysis of what kind of patients are
an analysis of what kind of patients are
an analysis of what kind of patients are we seeing as expected there was a lot of
we seeing as expected there was a lot of
we seeing as expected there was a lot of heart disease there was a lot of lung
heart disease there was a lot of lung
heart disease there was a lot of lung disease and an assortment of other
disease and an assortment of other
disease and an assortment of other diseases but almost catching up with
diseases but almost catching up with
diseases but almost catching up with heart and lung disease was a number of
heart and lung disease was a number of
heart and lung disease was a number of people trying to kill themselves
people trying to kill themselves
people trying to kill themselves organophosphate poisoning or pesticide
organophosphate poisoning or pesticide
organophosphate poisoning or pesticide poisoning almost caught up with a number
poisoning almost caught up with a number
poisoning almost caught up with a number of people with heart or lung problems
of people with heart or lung problems
of people with heart or lung problems critical care is not a health care issue
critical care is not a health care issue
critical care is not a health care issue it’s a social issue this is a social
it’s a social issue this is a social
it’s a social issue this is a social issue
issue
issue until we fix the poor farmer out there
until we fix the poor farmer out there
until we fix the poor farmer out there who doesn’t have enough to eat who is
who doesn’t have enough to eat who is
who doesn’t have enough to eat who is forced to actually think about taking
forced to actually think about taking
forced to actually think about taking his own life none of this matters it
his own life none of this matters it
his own life none of this matters it doesn’t matter if we build buildings of
doesn’t matter if we build buildings of
doesn’t matter if we build buildings of 100 stories high it doesn’t matter if
100 stories high it doesn’t matter if
100 stories high it doesn’t matter if you have airplanes which go 4 times
you have airplanes which go 4 times
you have airplanes which go 4 times speed of sound until we can affect that
speed of sound until we can affect that
speed of sound until we can affect that one individual out there who is right
one individual out there who is right
one individual out there who is right now right now sitting out there in
now right now sitting out there in
now right now sitting out there in contemplating you know life is not worth
contemplating you know life is not worth
contemplating you know life is not worth it until we can actually make a change
it until we can actually make a change
it until we can actually make a change there none of this matters some of the
there none of this matters some of the
there none of this matters some of the challenges technology is obviously going
challenges technology is obviously going
challenges technology is obviously going at jet speed things are going ahead
at jet speed things are going ahead
at jet speed things are going ahead healthcare applications healthcare
healthcare applications healthcare
healthcare applications healthcare procedures are going ahead at the pace
procedures are going ahead at the pace
procedures are going ahead at the pace of a running man the one thing that
of a running man the one thing that
of a running man the one thing that isn’t changing fast enough is doctors
isn’t changing fast enough is doctors
isn’t changing fast enough is doctors and health care’s adoption of these
and health care’s adoption of these
and health care’s adoption of these changes there’s an intrinsic in
changes there’s an intrinsic in
changes there’s an intrinsic in which I call you can’t see it well bits
which I call you can’t see it well bits
which I call you can’t see it well bits like a snail and some of the speed
like a snail and some of the speed
like a snail and some of the speed blocks are doctors themselves we are
blocks are doctors themselves we are
blocks are doctors themselves we are somewhat slow to adapt these things
somewhat slow to adapt these things
somewhat slow to adapt these things sometimes a good measure because you get
sometimes a good measure because you get
sometimes a good measure because you get this new concept it changes overnight
this new concept it changes overnight
this new concept it changes overnight and you think it’s not right anymore but
and you think it’s not right anymore but
and you think it’s not right anymore but sometimes they have to figure out can we
sometimes they have to figure out can we
sometimes they have to figure out can we actually affect change by integrating
actually affect change by integrating
actually affect change by integrating assimilating and collaborating with
assimilating and collaborating with
assimilating and collaborating with several other people
several other people
several other people I think this quotation I like to
I think this quotation I like to
I think this quotation I like to sometimes say because it’s very
sometimes say because it’s very
sometimes say because it’s very inspiring and optimistic quotation for
inspiring and optimistic quotation for
inspiring and optimistic quotation for me we really think the past is history
me we really think the past is history
me we really think the past is history the future is a mystery today is a gift
the future is a mystery today is a gift
the future is a mystery today is a gift and that is why we call it the present
and that is why we call it the present
and that is why we call it the present and and oppositely like this for me to
and and oppositely like this for me to
and and oppositely like this for me to share with all of you what I do where I
share with all of you what I do where I
share with all of you what I do where I can actually deliver intensive care to
can actually deliver intensive care to
can actually deliver intensive care to people who have not able to even touch
people who have not able to even touch
people who have not able to even touch who are far away but I can actually
who are far away but I can actually
who are far away but I can actually impact their lives this is a great
impact their lives this is a great
impact their lives this is a great beginning and a great opportunity and I
beginning and a great opportunity and I
beginning and a great opportunity and I think one of the reasons we’re all here
think one of the reasons we’re all here
think one of the reasons we’re all here because you never stop learning because
because you never stop learning because
because you never stop learning because life never stops teaching and I showed
life never stops teaching and I showed
life never stops teaching and I showed this slide to my son and he said but Dad
this slide to my son and he said but Dad
this slide to my son and he said but Dad you got to use what you learned so
you got to use what you learned so
you got to use what you learned so exactly so I think what we really need
exactly so I think what we really need
exactly so I think what we really need to figure out is can we actually make a
to figure out is can we actually make a
to figure out is can we actually make a change and affect change by simple
change and affect change by simple
change and affect change by simple things we keep our eyes open and help
things we keep our eyes open and help
things we keep our eyes open and help Pushpa
Pushpa
Pushpa Pushpa could be anywhere she might be in
Pushpa could be anywhere she might be in
Pushpa could be anywhere she might be in Dubai she might be in America she might
Dubai she might be in America she might
Dubai she might be in America she might be in India I think until we actually
be in India I think until we actually
be in India I think until we actually figure out can we make a change where we
figure out can we make a change where we
figure out can we make a change where we integrate our knowledge with technology
integrate our knowledge with technology
integrate our knowledge with technology and an intention to serve we will only
and an intention to serve we will only
and an intention to serve we will only then make a difference thank you
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