Bringing Hospital-Quality Care into the Home with Remote Monitoring and AI | Interview with Dr. Botho Mhozya, Head of Healthcare Delivery Transformation at Discovery

Ryan Purvis 00:20:48
Hello and welcome to the digital workspace works Podcast. I'm Ryan Purvis, your host supported by producer Heather Bicknell. In this series, you'll hear stories and opinions from experts in the field story from the frontlines, the problems they face, how they solve them. The areas they're focused on from technology, people and processes to the approaches they took, that will help you to get to the scripts with a digital workspace inner workings.

So, welcome to the digital workspace works podcast Botho, you wanna introduce yourself to everybody.

Botho Mhozya 00:21:23
Hi, Ryan. So I'm Botho Mhozya, a medical doctor by background I studied in Australia, and then finally made my way to South Africa to work for discovery.

Ryan Purvis 00:21:35
Wow, I did not expect that study in Australia, but that people leave there, but they don't come back.

Botho Mhozya 00:21:44
So I'm originally from Botswana. And one of the privileges is obviously good governance, all you had to do as a kid was get good grades, and then you could get a scholarship from the government. And if you got top tier grades you get to pick from the US, the UK and Australia. So that's how I ended up in Melbourne.

Ryan Purvis 00:22:04
Wow, did not know that. That's amazing. Okay, so let's get the user question out the way then we can go into this other stuff. So what what is the digital workspace mean to you?

Botho Mhozya 00:22:14
For me, it's exciting, because I'm passionate about healthcare. And very early on as a doctor, what I realized was, my impact would only be limited to those patients that I directly treated. But as part of my day to day job, you could see you know, how outcomes varied depending on which hands a patient landed in. So for me, I felt like to be able to influence healthcare, I needed to to join the dark side and join the insurance and the payers, because then you get to influence healthcare at scale. And then, of course, COVID hit and it really put digital technology to the forefront. So now it's it's the possibilities are infinite. When you look at healthcare, one of the primary issues is one healthcare expenditure. But also there's a lot of disparities. You've got communities that are previously disadvantaged, that don't have access to amazing healthcare. But digital technology almost turns that upside down. For me, I feel like, you know, when you look at innovation, such as hospital at home, which I'm leading, it's, I mean, it won't fix all of the issues that we experience in healthcare. But I think it will take us quite a few strides forward in terms of addressing some of the disparities that we've experienced in health care to date.

Ryan Purvis 00:23:40
Wow, that was the best answer I've ever heard for anything. There's so many things, I want to bet on that. So I mean, and you know, I mean, I grew up in SA, and I still think South Africa, or Southern Africa has some of the best medical capabilities in the world. I mean, we were, as I said, to to do before we start recording for the episode, we've spent time back in SA in the last three years, you know, the so called Bad time of South Africa. And we still treated better than them in the NHS is not terrible. Don't get me wrong. I mean, it's completely it's completely broken. And the void the beam taken off YouTube again for swearing. It's, it's a mess. And, you know, it's a mess when you got to wait six weeks to talk to your GP. Yeah, face to face. You know, my son needs to get his hearing test done. We had to wait six weeks for one appointment for the check for ear wax another six weeks for the next extra hearing test. I was actually saying to my wife, she had a kidney thing. Why not just flies back to Joburg for a week? Yeah, just do everything in a week and do everything that successfully, you know, and and that's where discovery, you know, as a provider, and you mentioned, the sort of health insurance world, the dark side, I mean, it's dark, I mean, it's expensive, and all the rest of it, but but we get so used to in South Africa, having the ability when you've got the means to go see a doctor. And your your points around technology being a multiplier. It is that I mean, I, you know, we my wife spent the whole day in a&e last week, two weeks ago, if eight hours were there. And we would pull it to post different doctors triage and etc. And we were driving home and we just said like, this is just an AI problem. Yeah, you know, do the blood test, do the list of that AI tells you what the potential things are. I mean, you could you could fill out a questionnaire getting blood tests in some cases. And that's where things South Africa and discovery, you know, like momentum are the two big players innovation there. And a very edge node a hospital home is because I think it's probably what I think it is. It's bringing that you're getting closer, closer to the source for the person. And I think that's an important step. So maybe I'll stop talking to that you talk because you got stuff to say.

Botho Mhozya 00:25:42
Absolutely. And I mean, I echo your sentiments. I mean, I've spent I've lived a year in the US and then been seven years in Australia, the South African health care, private sector is the best in the world facilities, you know, our doctors, etc. And like you rightfully says a lot of the issues that you experienced, for example, in the NHS, also in the US and in Australia in terms of waiting times, etc. That doesn't exist in South Africa. So if you've got a health care need in the private sector, you can get assistance quite easily. Obviously, that also brings, you know, its own kind of evils in the sense that you've got then got over servicing, and potentially high cost interventions that aren't typically a you know, necessary. But from a facility and from the skill of our doctors, I think we're definitely the best healthcare system in the world.

Ryan Purvis 00:26:33
It's interesting, I've never had mentioned over servicing, but we actually tried to explain to somebody yesterday about gap cover why you need to have gap cover. And we're trying to, and it's actually quite a complex thing to explain to somebody who's never grown up with with a private medical aid. Because when we explain to them that they're basically a medical aid or medical aid scheme is a pot of money, that's a risk based, and that the medical aid schemes will agree on what they'll pay for certain procedures, and is obviously a huge book of procedures. But you'll have specialists that will say that oh, well, you know, if the medical aid is telling me that the rate is x, my rate is 4x. Absolutely, that's why you need gap cover. Yep. And he was gobsmacked that there's a whole industry, I said, Yeah, and you just you have to buy medical aid, like, you know, if you got if you earn a salary, you have to have it. And then you have to have gap cover. And the gap covers like a small amount. But, but if you don't have it, you can talk, you know, six, seven figure numbers, if you get it wrong. So yeah, I mean, it's it's an interesting thing, but I think it's, it's where the world will go, I think the NHS has no choice. But to stop being the bottleneck, and to allow privatization. And I think the US which was, which was Obamacare, to some extent, which has been undone, was going down that route anyway. But it's, I mean, it's talking about the hospital home thing, because I think that's an interesting sentence, but let's unpack it a bit.

Botho Mhozya 00:27:58
Yeah. So hospital at home, as as an innovation has actually been around for I'd say just over 20 years, started in Australia, they're a lot more advanced than many countries across the globe. And it was essentially, initially, the concept of centered around elderly patients. So geriatric patients, what we know is if you remove them from the home, put them in unfamiliar surroundings, hospital environment, where there's alarms going off, there's no watches on the clock, the faces unfamiliar, most of them will, will get all sorts of complications, and one of them is is delirious, they'll get delirious and confused. And often what happens is they get sedated, or they have to get restraints. And then because they're also susceptible to falls, hospitals typically have slippery falls, and there's no one sitting at the bedside helping you, you know, navigate your room and go to the bathroom and back. So we know that if you take elderly patients put them in the hospital, one in three of them will have what we call an adverse event. If you look at the general population, that figure is one in 10. So hospitals will go to hospitals all the time, but actually hospitals are scary places to be, if you compared those statistics to any of your over the counter medications, or perhaps more applicable in recent times, if you look at the COVID vaccines, the stats of getting an adverse event were significantly less when you look at the COVID vaccine versus when you go into hospital for a procedure or for an admission. So what COVID Then did is it brought alternative care settings to the forefront, because the hospital systems were overwhelmed. You know, people couldn't get into casualties, they weren't enough beds, to be able to service and admit patients because of COVID. So we started looking at alternative ways to be able to still reach patients, because it was quite a scary time, you know, for health care, right? And we knew with COVID What typically lead to the high mortality was a phenomenon in healthcare called Silent hypoxia. So essentially, what happened to a lot of COVID patients was that, you know, they had an inflammatory phase that affected their lungs and their oxygenation would drop quite significantly. And it will often happen with patients not actually knowing that it's happening to them happened and people sleep or it happens and then there's delays to get access to care. So, you know, that's kind of what brought hospital at home to the forefront. At the same time we had already had telemedicine uptake was relatively slow. But you already had facilities such as you know, video conferencing call, etc. So hospital at home, takes all of that innovation, it takes remote monitoring devices that you can wear on your upper arm, or it can be a chest patch on your chest, it transmits up to 22 physiological parameters. So if you've ever been in an ICU, all those fancy screens you've seen on TV, if you've ever watched Grey's Anatomy, etc. So you will know you have all these big screens, and you have all of these vital signs, heart rate, you know, oxygen saturation, respiratory rate, blood pressure, and all of these patients are monitored 24 hours a day. So remote monitoring technology, minus all the wires that would restrict your movement allows us to be able to then monitor patients remotely. So that means if for example, you get diagnosed with pneumonia, and you need IV antibiotics, etc, we can now admit you into your home, we'll have nurses coming into your home on a daily basis. To give you all of the necessary treatment that your physician has prescribed, your physician is able to still do a virtual ward round and connect with you through the platforms and see how you're doing, you're able to to chat to the doctor 24 hours a day if there is a need. We've also got a what we call a clinical command center. And this command center is is situated here in Johannesburg, we've got emergency trained doctors who literally have all of these big screens, and for all our patients are monitoring their vital signs 24 hours a day. So if you deviate from your baseline, and alarm will trigger on the dashboard, and those doctors will call out to you and determine whether you know, there's a massive issue. And as part of the platforms that we did, so we partnered with a company called Biforst initially formed out of Singapore, but now based in the US. So they provide the hospital at home platform and remote monitoring technology. What superior about by far miss is that they've also then integrated AI technology into the platform. And what and their technology is called the bio vitals index. And they developed they co developed alongside Harvard, it is FDA certified. And what this clever little technology does is for every single one of our patients who are admitted into hospital at home, it establishes a baseline for you. So within an hour, it knows what Ryan's baseline heart rate, blood pressure, oxygen saturation is, and it monitors very subtle deviations. So even before you would feel physically unwell, it's already picked up that you've deviated away from your baseline. It collects other kinds of clinical information like movement, sleep, etc. So it's able to then say, well, he's not active at the moment. So we can't explain this deviation through motion, or increased physical activity. So then this is a fundamental issue. And what we've seen for some patients that I'll give you a case study of a patient, male patient known with prostate cancer, known heart failure patient was admitted into the program, all the vital signs looked within normal, I mean, nothing that would have been alarming. But this bio vital index was trending upwards. And when it reaches a certain threshold, the recommendation is to transfer the patient back into hospital. The patient at this point felt fine, physically fine, no complaints, the patient reviewed by a clinician in the hospital blood tests were run, everything looked normal 24 hours later, I kid you not. This patient then developed what we call an intestinal obstruction. So basically a blockage in their bowel, which if they hadn't been in the right setting, wouldn't have had the right treatment in time. So what this then does is it adds a second layer of of rigor and reduces the medical risk, because most people will say, Well, what happens to me if something goes wrong in the home? Can you get to me quickly, right? So the AI technology is actually able to pick it up even before you will become unwell. And what we've seen is, before the medical event happens, it's usually a timeframe of about 24 to 36 hours. So we've got plenty of time to transfer you into hospital and get you the necessary workup that's required and access to care that that we need.

Ryan Purvis 00:35:08
Amazing, amazing. I mean, I was getting goosebumps while you're talking. Just just because, I mean I've built systems like that similarly, not for humans, for for self healing desktops. And it's all a very similar premise. And, I mean, I use an Oura ring, which I'm sure you're familiar with. Yeah. And that's basically my indicator. So I know and I check it pretty much every single day now but probably every second or third day. And when I'm starting to feel a bit rundown, I go and check my temperature. And I don't check the spot box. I check the trend and I can see there we go temperature is going up. I'm going to be sick for for the next day. And I mean, as you know, based on just having a little bit of indicator I'm not so worried about so much that being sick anymore. Because I know, I know enough now to be self aware, to the extent of your own body. And then I go to the doctor, and I use the Apple Watch for for blood oxygen. And I go check that if that strop like to 93 95, then I know it's something more like more reason to take it easy. But if my blood oxygen is back at 100%, and I'm like, I was probably just a bit of sinus or a bit of allergies or something. And I just, you know, you're so it's so much more sophisticated than my sort of layman view. But there's people that don't even do what I'm doing.

Botho Mhozya 00:36:22
Don't even do that. Exactly, exactly.

Ryan Purvis 00:36:25
And I mean, it is on the, on the scary side of science fiction, in some respect that, you know, you'd be monitored remotely by a big, you know, Control Center, and they're looking at your vitals, but, but it's a painful service, you're, you're wanting to do it, you do it by choice, as a patient. And I was just wondering, I mean, you know, besides your case study, but if you had that, if you've got a person who's come on to the service, because now they're aware of it, they, you know, obviously, they've signed up to it, do you bring them into the hospital periodically? So they have they've built that familiarity, that they're going to the same place? And then started home?

Botho Mhozya 00:36:59
So not at all. So but yeah, so the entryway into the admission is you would typically have gone to a casual to an emergency room, you see a doctor there, and the doctor, you know, examines you and says you do need inpatient care. But the following that process is, well, what is the level of care that you would require if we had admitted you into hospital. So there's typically three categories of acuity in the hospital. So most patients will go into a general ward. Yeah, the next level of patients who are sick, but not like too sick would probably go into a high care. And then if you're really sick, you're going to go into intensive care. Now, if you unpack what typically happens in a general ward admission for people who have been admitted, you will typically have a nurse come to your bedside once or twice in a 24 hour period. And at that point, they'll take your blood pressure and all of your vitals, give you your medication, and you won't, you'll likely not see them again until your next doses do. So as blind spots in terms of well, in between these visits, what's happening to this person from a physiological perspective. And then of course, there's all of the inconveniences that come with it, your family is restricted to certain visiting times, you've got to drive around the hospital, try and find parking. You know, the coffee in the coffee shop is really crappy. And the food is not the greatest. Right?

Ryan Purvis 00:38:21
Right. Look, a hospital in South Africa 10 times better than a hospital in the NHS Trust. Yeah, and we got that's true. And parking. I mean, I mean, Don't even joke about parking. Like, you know, we got a friend who's gonna shed it permanent at Eastside, which is a royal sorry, very good hospital. And she spent an hour trying to find parking. Now, who's got it out? I mean, nevermind the hour drive to get there. So, so who's got the time? Like, you know, to do that? So this? I mean, you mentioned that video calls us up. And we do that, obviously here as well. But there's got to be a level of of modernization. We're going to see someone physically when you when they I mean, yes, there's some stuff, you still have to like, move somebody's arm to see that it's working. Potentially, you know, there's still those sorts of checks. But the majority of checks could be done to through telemetry? Yeah, absolutely. Which Which makes sense to me. So sorry, carry on with what you're saying? Absolutely.

Botho Mhozya 00:39:21
So yeah, the entry point into hospital at home is is now when you're seeing your doctor in your casualty or in the doctor's rooms, they if your level of acuity is the general ward, right, they now can make the decision to say, well, let me actually admit you in your home. So they've done the whole physical examination, they've taken a history, they've done a workup, they're quite clear on what they treating, and it's pneumonia, for example, they would then, you know, admit you into your home. So they would go through the same processes and send through a pre authorization to us. And we would approve for your admission in the home. Critical is your entire episode of care, your admission in the home is funded as it would in a normal hospital. So the patients aren't out of pocket. So even for the technology, etc. The patient isn't out of pocket for any element of that admission that happens in the home. And that initial face to face encounter with the with the doctor is meant to essentially risk stratify you right to ensure that we're putting the right patient into hospital at home low acuity patients, because the last thing you want to put is a patient who you know it within 24 hours or 12 or 12 hours has a high likelihood of of ending up in the ICU. Those are not patients that you want to admit into into hospital at home. So once that initial face to face encounter has happened, the patient goes home and the nurses will bring the technology set it out up. If you need chest physio, for example, the physiotherapist will come into your home and provide that. If you need a low dose oxygen, we'll have the oxygen delivered into your home. So everything that is prescribed by your doctor is then delivered into the home by discovery.

Ryan Purvis 00:41:03
And I'm just thinking about the logistics of that. So because you're monitoring these people are anomalies are we proactively, because you are, I mean, you'll have baselines and that kind of stuff, you I mean, your abilities to logistically manage resources. So to have the nurses go at the right time to have all the things to be available sort of just in time mentality. I mean, that must be so almost like, almost like conducting an orchestra, you know, because you can get such a harmonious experience, because in theory, if everything works that because you know, you can you have that visibility, because often, you know, and I go back to my example here of the NHS, if they don't plan ahead, so they're always reactive to the situation. So So GPs are always behind the eight ball. Because they can't they still did it the old way. Yeah. But because you've got this information. And yes, you started with elderly, but you can go further further down. Yes. Your ability to capacity manage, and to capacity management resources that are not geographically constrained. So you can't you don't need to have a doctor in Joburg to see you. You can go see like my uncle's in Knysa, but he flies to Cape Town to see his surgeon, his heart guy. Yeah, you know, now doesn't just have to do the flight, he can just do the video call. And they got to my dad's in his pacemaker. So let's say the pacemaker was smart, as insecure, of course. But they can pick up the data there. So that they don't have to do the drive. But as like 77, for him to go into the hospitals a big admission, he'd probably fall into the service. Yeah, you know, I could just think about the benefits to them. I mean, that's the great thing about this, you can feel the benefit to sitting here thinking about. So I mean, what has been the what have been the challenges to adoption to this.

Botho Mhozya 00:42:41
So the major challenge both in South Africa and globally, is, as you can imagine, doctors and their health system is traditionalist in nature. And because we've done things the same way for such a long time, it's difficult to kind of change people's perception. So change management is is a massive issue. But what has kind of been the catalyst is COVID, as I've said, because it absolutely turned the notion upside down, that serious illness could only be treated in the confines of a brick and mortar hospital. Through COVID, we saw that we could actually do things differently. And we treated many patients throughout the pandemics quite successfully in the home. So it's it's it's one conversation at a time. It's changing one doctor's mind at a time. But it's also in having them understand that from a clinical risk perspective, because doctors will often ask, well, what are the medical legal implications? Am I putting myself at greater risk by treating patients in the home. And it's not. It's only until they understand the clinical evidence and the rigor behind the program, that you're actually able to demystify that. If anything, you've actually got greater risk in a general ward in a brick and mortar, given the evidence. And over the last 12 years, there's been quite robust clinical evidence that's and clinical trials that has been done around hospital at home. And what we know is patient satisfaction is obviously significantly better. You're sleeping in the comfort of your own home, eating your own food surrounded by family and loved ones and familiar surroundings. And then the second is around the quality outcomes. So we typically in healthcare would measure once a patient is discharged from hospital, we would measure the 30 day readmission rate, how likely are you to land back in hospital after being discharged out of hospital? We also then measure your utilization of casualty post the admission, so how likely are you within 30 days to bounce back into the casual team. And then obviously, there's things like mortality, there's hospital acquired infections, etc. So when you look at hospital at home and compare them to the clinical twins in a traditional brick and mortar, the quality is far superior. You actually have zero hospital acquired infections because you don't have any hospital superbugs in your home for most people, and then your 30 day readmission rates and casualty utilization is also significantly lower. And people recover easier, they mobilize faster, and they recover quickly. So the length of stay significantly lower as well. And then, of course, from a health financing perspective, when you look at the cost of a hospital at home admission versus the same exact admission in a traditional brick and mortar. In our data, we're seeing that it's 30% more cost effective. And it's no different from the evidence that has been published internationally. So what's unique about this model is irrespective of geography, the outcomes we're seeing exactly the same to the robot?

Ryan Purvis 00:45:53
I'm surprised you say the same, I actually would have thought they'd be better. And not just because it has to be better. But I would think because you are reducing the cost to the customer, the patient because you are treating them in their home environment, their back, the bounce back would be better. And because you're only bringing them into the hospital when you need to your hospital capacities would be would also be better managed. Yeah, absolutely. So I mean, it's not to say that the same I think it I think it's it is better. And I think going back to, to sort of the brick and mortar, the brick and mortar problem, which is maintenance, and space utilization and all those things, there's probably, you know, unmeasured benefits, absolutely. Absolute to to the hospitals.

Botho Mhozya 00:46:36
Yeah, particularly in the context of South Africa, right, we've got 60 million South Africans, the private health care sector only services, 9 million South African. So there's massive disparities, and we know that our public health system is is overwhelmed. So if you look at hospital at home, that says, and, you know, globally, we've also got another problem, which is, you know, specialists are very few. So doctors as a whole are very few. And waiting times to see an endocrinologist, for example, even in Johannesburg is anywhere between three to six months. But if you plug them into the digital ecosystem, using remote monitoring technology and telemedicine, that endocrinology, you can actually now extend the reach of the endocrinologist, right? Because you're now bringing in efficiencies into their practice. So what what I think will happen over the next couple of years is clinical practice will change into a hybrid model, where they will always be for the really, really sick patients that face to face encounter. But for people who would be serviced in a general ward, that care will transition more and more into the virtual ecosystem. And then because of the rapid pace at which AI is also developing, you know, in healthcare, I think we're going to become more efficient as clinicians in the way that we treat our patients. Because if you look at health care expenditure, up to about 10%, of healthcare expenditure is attributed to medical error in the US that numbers is estimated to be anywhere between 18 billion to around 20 billion US dollars, that's spent on medical error, right? So if you've got AI technology that takes in all of these different inputs, and gets you a precise diagnosis in a short amount of time, imagine what the possibilities are right? It means you get access to the right level of care in a shorter timeframe. And so your ability to recover, and the impact of your life is significantly improved. Going forward?

Ryan Purvis 00:48:46
Yeah, no, I mean, it makes a whole lot of sense to me. And I was thinking while you were talking, you know, the amount of doctors rooms, you go into where they were, they do run late, because of the transition time between patients. But if, and you would have seen this, you know, again, through COVID, whatever was kind of brought to the same level, there is no transition time between meetings, per se, because you're just going back to back to back, which is not a good thing, either. Don't get me wrong, but but it does create boundaries, in some respects, and you need to be, you need to block your time out appropriately. But I think that's also the benefit to a lot of these, you know, specialists, or consultants. Because when you have that transition overflow, you never have time to do the work. Yep. But now because you can block out your diary and stuff can only be booked in your diary, it's open, you can be a little more predictable as well around how much consulting you'll do. And then if it's going through a digital channel, you know, we're doing it now we're transcribing this call that transcription is now happening, okay, may not be good. I mean, it may not be as good as you know, it could be, but it'll get better. But that also cuts out a lot of a lot of noise. unnecessarily. And I do think, you know, a, I have been involved there, again, to listen to symptoms, too, that are that are not necessarily picked up by everybody, and analyze and go Well, you know, he said this, he said this, but he also said this thing, which you said this might be a cough, but actually it sounds like, you know, predicted, you know, 30% charge more of pneumonia or like my dad, you know, he has that some stuff. They could have probably picked it up six months earlier. They just were looking for a little bit extra, which which model we'll look for because it can process you know, in a few seconds minutes.

Botho Mhozya 00:50:23
Yeah, absolutely. And I mean, I often say to clinicians as we speak to them around hospital at home and digital technology is AI will not replace doctors. Never but doctors we embrace AI will replace doctors that don't. Yes.

Ryan Purvis 00:50:41
Here's what I mean. We met some guys in Egypt a couple of months ago. And he's a radiographer and I was asking him about it. X rays and MRI is going through AI. And he said, you know, it, like some things, it's really good. Like it picks up stuff that we didn't pick up some stuff that just can't it can't do it. But we'd really makes a big difference is we've got a backlog of X rays for COVID, like six months, and we're just putting it through that. And it's literally turning around, like two or 3,000 X rays in a day. And we only have to look at 300 of them. Because that's couldn't tell anything. Like that's where it's huge. Like, yeah, well, that's, you know, that's, that's where it adds the value is is throughput.

Botho Mhozya 00:51:19
Yeah, absolutely. So it actually frees you up to do you know, the high order thinking tasks, the super complex that AI is super complex for, you know, the example that you gave with your radiologist is those, you know, complex scans, etc, they can now spend more time focusing on that versus your plain film X rays where the bulk of them are normal in the first place.

Ryan Purvis 00:51:42
Yes, exactly. And, and I think, you know, and I've seen it a little bit here and there, and I guess there's a level of trusting the platform that you're working with. And, you know, I'm a big fan of the vitality brain, which we've talked about where you know, you've given your steps and you get benefit from doing it. And I think, I think that's one of the reasons why vitality and momentum with multiplier have always done well, because they avoid people getting sick because they get teaching them good behaviors early on in life, lifting weights, doing exercise, all that stuff, going to watch a movie as much as its people laugh about it, but actually going to watch the movie relaxing, you know, provide you don't eat all the all the chocolates and the slash puppies. It's probably good for you. But what I was getting into is that I am seeing like with with a lot of corporate packages, here, you're getting an app that you will that you'll recall your book, your call your GP, they're asking you some basic questions like How have you slept? What's your mental state those things? Now, people can still lie about that stuff? Which is why you need the telemetry to back it up. Yeah, because some people do live in a in a in a distorted world where they think well, I slept well last night. But actually, if you look at the data, you tossed turned and you got up four times, and you didn't sleep well at all. That's an important thing to somebody who's trying to be trying to be rational about their symptoms, because if they haven't slept, they're not going to be rational. Yeah, absolutely. Absolutely. And this goes to, you know, other things you mentioned, restraining people sedating and etc, multiple days of not sleeping, well, will lead somebody down the route of going crazy. I mean, yeah, basic behavior. So I mean, you're you guys are doing that in South Africa. Only at the moment, are you going into the other countries as well, just I'm just curious about how far

Botho Mhozya 00:53:25
So we're doing it in South Africa at the moment, but we are looking, you know, in the next two to three years to then, you know, export the model into our other partner markets. But as I said, we're not the only you know, health system that's doing hospital at home. There's, you know, an expensive list of hospitals in the US that are running hospitals and home programs, the likes of your Cleveland Clinic, Mayo Clinic, the Brigham and Women's messaging, etc. And then more. And then in the in the UK as well, given the issues that we're having in the NHS, you'll know that coming out of COVID, the NHS has a bold ambition where it wants to actually convert actually establish, and they're calling it bit to anywhere between 50 to 70 virtual beds per 100,000 people in the UK, and they're trying to scale up in the next year to 50,000 virtual beds. So as opposed to putting patients into hospitals. Yeah. So they've right now they're they're servicing around just under 2000 patients on a weekly basis in the virtual bits. Yeah, but they are aiming to to expand that quite significantly, to G decongest, the hospitals and address some of the issues that are being experienced that side of the world as well,

Ryan Purvis 00:54:45
which in particular makes me laugh because you're telling me the stuff. And actually, the biggest problem was that they try and channel everything through a GP. And until you break that bottleneck, it's all this other stuff is just not that not the it's they haven't they haven't taken back the first principles, which is hit connect the customer to the service they need directly without having the bottleneck because the bottleneck is the GPU right now. That's why it takes so long to get to the senior body because you have to go through a GP,

Botho Mhozya 00:55:12
there's still science, there's no science behind that, right? Because the strength of a health system is determined by the strength of its primary care, right? And GPS being the navigators when it comes to patients. So what we know is when you look at the costs generated at a primary care level versus at specialist level, they are vastly different, more expensive in the specialist realm. And if you think about it, specialists in in the training that they've done, is to pick up the really rare and complicated stuff. Yeah, sure. So a GP treating a pneumonia versus As a specialist treating pneumonia, the cost delta is is quite significant. And so well, in a well in a health in a well functioning health system, you actually want patients seeing the GP first, and only those who really need specialist k then transitioning into into the specialist. So it's less about, you know, the GP being a bottleneck, perhaps they aren't enough GPS. And that's where the issue is. Yeah.

Ryan Purvis 00:56:13
So and yes, there is a silly limitation here to number of GPs trained per year, I think they only train 12,000 A year or something silly like that. And I get what you're saying. I mean, I, that's why I say I think I think where they're looking to solve the problem with going to virtual beds, they're probably still not looking at the right place to solve the problems, which is, which is the GP, because in South Africa, you know, if I want to go and see a physiotherapist, I found the physiotherapist and I go, Yeah, but if I want the NHS to cover my physiotherapist, I have to find the GP first to get referred to the physiotherapy pathway. Yeah. And and when you got privates here, you used to be able to refer yourself. Now you also have to go through the GP first. So now you've had this double whammy of well, I hurt my calf, and just need someone to go work on it. And I'm now going to work like, by the time I've gone through the whole process of six weeks, I fixed my own issue because I've gone in massage my own leg, or I've gone to somebody you know, what I'm saying is I haven't solved the matter. So complicated. You just don't solve the problem. You don't go do anything about it, or you just live with it. And I think that's where you know what you're doing with hospital in the home? And you miss I mean, yes, it's tied to the elderly. But I think there's lots of people we're going to enable who's got MS. She probably would benefit from hospital at home. You know, her husband works the NHS, funnily enough. And he's out for long shifts. If she falls, none of us will know. Yeah, because the thing that I was thinking about when we started the call is a South African lady as well. She was running a company where they were building a robot, basically, that moved around inside the house with sensors and cameras and the pill dispensing and all that stuff. I met with the company, I think it's called crayon might be my background. But the idea behind that was one to be a psychological partner for the person. So they could talk to they could talk to anyone in your time because it was there was a microphone and a speaker and a camera and a camera and a digital screen. But then also they pull the be brought to them to put it to take the pills, they could do their biometrics through their like blood pressure, like so it was a very fancy idea. I don't know how far they've got. But I was thinking about, would that be part of your solution? And it sounds like you're kind of doing that some of the things. And I'm wondering what are they actually you mentioned wearables. So what does somebody actually get? They get like what they need? Or do you give them like a basic kit that they have to wear certain things or...

Botho Mhozya 00:58:36
So each each of our nurses when they come into the home to onboard, the patient comes in with a kit. And as part of that kit is the variant device, very small device, slightly bigger than an Apple Watch. They wear it on the upper arm. And that's it. It's a rechargeable device. Once it's charged, it holds charge for up to 18 hours, which was obviously important in the South African context in the background of load shedding, etc. So our nurse also comes in with a UPS battery. Because the next question as well is the interruption in monitoring during load shedding. So our nurses will also come in with a UPS batteries. And then obviously what was important to me in designing the program was that it shouldn't be an elitist product. Meaning if you're sitting in a township, and you don't have WiFi in your home, because the remote monitoring device needs WiFi to transmit to the dashboard. You shouldn't you shouldn't be excluded out of hospital at home. So what we also do is we then provide the patients with a smartphone that has mobile data, they're able to chat with the clinical care team through the app very intuitive, even our elderly patients love it. And with the scenario that you gave earlier on around, you know, most people living alone or loneliness, particularly in the elderly population, we find that they love it the most. So they will be chatting 24 hours a day, asking the doctor what they've had for tea and all of that jazz. So super intuitive and easy to use from a technology perspective. But the nurse brings every single thing that the patient requires. So we will set it up and use it. It doesn't restrict your mobility, there's no wires connected to it at all. Very comfortable, you can sleep with it, it's not going to disturb your sleep. And through the dashboard, we're able to monitor connectivity, you know if the WiFi is good, or if the mobile signal is poor, and we're able to swap out the SIM cards for example. We're also able to monitor the battery life on it. So if you're running low, we will pop you a message and say just put it on charge. And within an hour it's fully charged as well.

Ryan Purvis 01:00:37
Oh wow. Fast charging. Check. Yes, good.

Botho Mhozya 01:00:40
Yeah. So from our from our perspective where device agnostic because the technology is evolving at such a rapid pace We are looking to obviously bring as much convenience as possible into the home. So when you talked about the pill dispenser, there's actually now, you know, small little pill boxes that, you know, at nine o'clock, if it's time for you to take a certain medication, it will dispense exactly the right amount of dose for you. And this becomes important for your chronic patients who've got multiple chronic conditions with multiple different pills that they've got to take and usually get confused in terms of Well, what was I supposed to take? Now? What is it for right? So these little devices actually take the math out of this, and it will dispense the right amount at the right time. But what's also intriguing is, you're able to remotely adjust the patient's doses. So once the, the doctor gets the blood results back, if they need to increase the dose, they can, they can modify it remotely. So at the next dosing, that patient is already getting the new dose.

Ryan Purvis 01:01:47
Wow, that's so cool. And then are you doing other stuff like weighing them and taking blood? I mean, the nurse will do blood draws, obviously, yes, every day or the app.

So we do for our heart failure patients where it's critical to to measure the weight and how it fluctuates. They've got the digital scales immediately, when they hop on the scale, it will transmit the weight to the remote dashboard, the nurse will draw the bloods as required. But even in that space technology is is evolving quite rapidly. And we're now having, you know, point of care devices where you can do you know, the basic lab panels that you would need for an admission, when we look at most people will then ask, Well, what happens if I need an X ray? That technology is also rapidly changing. Fuji, for example, has a portable X ray machine that we're looking at at the moment, which the nurses could carry at sizable, it's not big, it's not heavy, they can carry into the home and be able to do the X ray in the home.

Holy, moly, portable extra, literally a portable,

Botho Mhozya 01:02:49
portable X ray machine,

Ryan Purvis 01:02:50
I was thinking about it, I had cash and carry truck size now who driving around,

Botho Mhozya 01:02:54
not at all. So if you need an X ray, you've got portable ultrasound, you connect remotely to the cardiologist, for example, and you do a scan of the heart, they can see everything in real time. They they're able to also remotely guide the technician in terms of the exact area, the depth and all of that.

Ryan Purvis 01:03:13
Wow, that is amazing. I can't actually believe it. I mean, you can believe it exists, but you can't believe it exists. If you don't I mean, I mean, it's very it's it's, and I mean, we talked about loadshedding for a second. I mean, you know, I'm assuming that with, with even that kind of constraint that South Africa has at this point in time, you know, eating our battery for device. I mean, you could charge you mentioned our charging. What about the other devices? I mean, you control centers, probably running on generators, and all that as well. And is there redundancy there like another backup backup unit, somewhere or

Botho Mhozya 01:03:47
so we've got our generators, in all of that stuff, we haven't had any issues in terms of being able to monitor patients. But as you can imagine this discovery, we've got access to that infrastructure to ensure that we obviously don't compromise patients. But even in the hospital, your traditional brick and mortars they've also had to put in to place those types of processes, generators, etc.

Ryan Purvis 01:04:09
Yeah, so what I mean by that was an actually actually sold some off eBay. So I would have had to make sure it's done that I wouldn't go see a biokineticist who I'd only made the appointment with the day before. And he was like, oh, yeah, but you actually just have a look at them. Yep. So he didn't have to even get get them for like, you know, obviously, cuz I've signed up with him, he got permission to see my stuff. But I was wondering about that sort of thing where, you know, you've got a patient that that falls, the neighbor calls for an ambulance, they pick up the patient and take him to the hospital. You guys would know about that? Because you've got telemetry and all the rest of it. Yes, absolutely. How how do you I mean, let's think about this. And like, what about HIPAA, sharing of data, that sort of stuff? I mean, do you do you think that there'll be a sort of alliances between all these different platforms, data, or even anonymously shared data to improve the the algorithms?

Botho Mhozya 01:04:57
Yeah, absolutely. So so the data is, is and I mean, all of this technology works within the confines of exactly that, those types of regulations, as long as there's no patient identifiers, etc. That's how it's it's able to, to kind of work in a in a secure and safe manner. And then obviously, there's patient consent in terms of, you know, who you can share the data with, for hospital at home, each patient has their care team. So it's, it's multidisciplinary, it's the physician is the remote command center, it's the nurse, but your data is only shared with your clinical care team and no one else.

Ryan Purvis 01:05:35
Yeah, yeah, that makes sense. Right. There's been a lovely chat. I really enjoyed it. Do you want people to be able to contact you or do you want them to go to a specific place to get more information?

Botho Mhozya 01:05:45
Yes, absolutely. For for patients who are interested in it hospital at home and learning more about it. On our discovery website. We do have a hospital at home page. You can also email us at hospitalhome@discovery.co.za. And we'll be happy to give you more information about hospital at home.

Ryan Purvis 01:06:04
Fantastic. It's been a really great chat. I've really enjoyed it. Thanks for coming on.

Botho Mhozya 01:06:08
Thanks for having me, Ryan.

Ryan Purvis 01:06:11
Thank you for listening to today's episode. Heather Bicknell our producer and editor. Thank you, Heather, for your hard work on this episode. Please subscribe to the series and rate us on iTunes or the Google Play Store. Follow us on Twitter at the DWW podcast. The shownotes and transcripts will be available on the website www.digitalworkspace.works. Please also visit our website www.digitalworkspace.works and subscribe to our newsletter. And lastly, if you found this episode useful, please share with your friends or colleagues.

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