In a newly released podcast, Cadence Founder and CEO Chris Altchek sat down with Dr. Omar Lateef, President and CEO of Rush University Medical Center, to discuss how technologies like remote patient monitoring (RPM) will transform the future of health care and help drive more health equity in the wake of the COVID-19 pandemic.
The conversation took place as part of the inaugural episode of Cadence Conversations, a new podcast from Cadence where we're talking with prominent physicians, healthcare leaders, and tech entrepreneurs about their experiences driving innovation and progress within the healthcare system.
Over the course of the episode, Lateef opened up about his own personal journey, from ICU physician to healthcare executive. Today, Lateef is the President and CEO of Rush University Medical Center, where he has received national attention for effectively managing the COVID-19 pandemic and was recently recognized by Modern Healthcare as one of the 50 most influential clinical executives.
"You go into healthcare to make an impact," Lateef said. "And if you're a great doctor, you're making an impact one patient at a time. If you create a program that takes 1000 transfers and one month that otherwise wouldn't have been able to have access to that level of care, you can make a much bigger impact."
"So the real desire in doing this is to really make an impact and make some meaningful difference, and that's, I think, been the thrill."
Lateef explained how he and his team are thinking about the role of technology in healthcare in the wake of the COVID-19 pandemic, and the lasting impact that he hopes COVID will have on the way that healthcare gets delivered across the country.
"What's happened with COVID is it has, in front of our very eyes, highlighted what inequity does. It highlighted how inequity kills and it highlights how we have a medical system that doesn't reach all people and doesn't provide the same level of care for all people," Lateef said.
To address those gaps, Lateef discussed how Rush is utilizing technology like RPM and other forms of telehealth and virtual care. "I think any technology that opens up access for people in areas where they can't get access is mission critical to improving the health of our nation. And I think that has to be our goal," he said. "And I would say what we are trying to do is have phenomenal healthcare for all people all the time. And if you say that's your goal, then you can build in ideas like open access, from very subacute televisits, to very acute at home monitoring."
Listen above to the entire conversation and be sure to subscribe to Cadence Conversations wherever you get your podcasts in order to listen to future episodes.
Also read the full transcript of the conversation below:
Transcript for Ep 01: Technology’s impact on health outcomes with Dr. Omar Lateef
Table of Contents
- Dr. Omar Lateef on Becoming an ICU Physician
- Burnout in Healthcare
- FaceTime and Zoom as a Platform for Telemedicine During COVID
- Dr. Lateef’s Perspective on Leadership as a Healthcare Executive
- Dr. Lateef on Healthcare Administration Career Insights
- COVID as a Catalyst for Health Systems Ongoing Transformation
- Rush System Health Equity Framework
- Increasing Access to Care Outside of the Hospital
- America’s Policymakers and Local Hospital Systems
This week, our CEO, Chris Altchek, had a chance to sit down with Dr. Omar Lateef, president and CEO of Rush University Medical Center. Under his leadership, Rush received national attention for its effective management of the COVID-19 pandemic. The two of them discussed Dr. Lateef's transition from ICU physician to healthcare executive, the lasting impact of the COVID-19 pandemic, and how technology can play a role in creating better healthcare equity. So let's get to this week's Cadence Conversation.
Chris Altchek (CA): Dr. Lateef, thanks so much for speaking with me today for the very first episode of Cadence Conversations, our new podcast here at Cadence. Without further ado, let's jump into it. Hello, Dr. Lateef and welcome.
Dr. Omar Lateef (OL): Thanks for having me.
Dr. Omar Lateef on Becoming an ICU Physician
CA: Take us back to the beginning. Why did you decide to become an ICU physician?
OL: Well, I will say, Chris, that I've always loved medicine. I loved internal medicine. [When] I started my residency, I was at New York University Downtown Hospital in Manhattan, and my mentor down there was just a great physician leader, Dr. Fabio Giron. I would follow him on rounds and I just felt like he knew everything, and he just took care of human beings, and he had amazing outcomes. And I think that when you look at critical care of medicine, it's internal medicine on steroids, and there's so much passion that goes into it. And there's a spirituality that comes with end of life issues. And I think that combining all of that together with the science behind healthcare was just something that was really appealing to me. And like anybody else, following the footsteps of a giant was something that I really enjoyed doing.
Burnout in Healthcare
CA: It's a career that's infamous for physician burnout. Very few physicians last in the ICU for more than a decade, given the intense pace. How have you managed to survive and thrive for so long?
OL: I would say today, burnout is nonspecific in healthcare. It is hitting everybody in every field in healthcare. And the reality is everybody I know works so hard to make a difference. And then when you factor in the normal stress of your day to day job, that leads to physician burnout and other healthcare burnouts. Specific ICU burnout, I don't think is any different nowadays. I would say that what drives people into their field of healthcare is a desire to make an impact and desire to make a difference. What drives people to be burned out is when you're not able to make an impact because everything else is pulling away at you. I think they've been burned out because of all the external forces there, everything but medicine, to take away from their ability to treat human beings.
FaceTime and Zoom as a Platform for Telemedicine During COVID
CA: Those end of life discussions are really difficult discussions you have with family members, often as an ICU physician. Many of those got transitioned to FaceTime and Zoom during COVID. Did you learn anything about telemedicine and really connecting with patients and their family members in these very intense moments through that? Through the last two years?
OL: I think that telemedicine offers huge advantages to healthcare, huge improvements in access, and huge potential opportunities down the road to improve outcomes by offering a visual platform to somebody. So you can get a history over the phone, but you can get a visual platform that can help. I think, specific to end of life care, it's something so spiritual and so important. It requires wherever and whenever possible, people sitting in a room talking to each other. Certainly, being able to FaceTime somebody was better than not being able to FaceTime somebody. But I don't think it could ever take the place in end of life issues. I think that those are issues where you really have to be in a room, you really have to have a feeling for how you're going, where you're talking, and what the level of understanding is with one another.
Dr. Lateef’s Perspective on Leadership as a Healthcare Executive
CA: I couldn't agree more. Pivoting to your experience as the president and CEO of Rush University Medical Center, what inspired you to go into leadership and how do you balance such huge responsibilities with such demanding clinical responsibilities?
OL: Well, I think the second part's easy. I think unfortunately, as much as I love medicine, one of the realities is when the burden of the administrative roles take over, you give up more and more and more clinical time. And then you wake up one day and you realize you're not even a doctor anymore. You don't even know who you are. You're looking in the mirror and you lose a lot of your identity. Healthcare leaders need to be healthcare providers, in my very humble view. Being able to understand the trials and tribulations of people who are working allows you to help solve their problems. And if you don't have some semblance of understanding or incredible relationships with those who are providing care, I've always believed it's just harder to understand. Now, that doesn't mean you can't be a phenomenal healthcare executive without coming from being a provider.
I think being a provider gives you an ability to understand just a little bit more maybe early on in your career. And for me, it made a huge difference. And so my journey in administration happened out of happenstance. I was standing in the ICU one day and I got a page from the chief medical officer who told me I had too many central line infections. That's analogous to telling a parent you're not a good parent. You take a lot of pride in your care. And I called him up and I was pretty angry. I was like, "What the hell kind of text is that?" And the feedback was well, "That's what it is. That's what the data shows". And I didn't understand the data. I didn't understand how that could be, because we were a very vigorous transfer program and the patients we brought in were really sick.
So I said what every other doctor in America has said for years, "My patients are really sick so that doesn't count". He said, "Prove it." And we entered into a journey of trying to understand quality and try to understand metrics and how quality was measured. When we did that, we found that it's not a perfect system and that providers all over the country are getting dinged for outcomes that they don't deserve to be dinged for. That doesn't mean that as a field, we shouldn't police ourselves and make sure that we work to a standard of care. It really does mean we have to understand if the metrics that we're following give the results we believe they're giving. So in trying to prove that, I learned a lot about healthcare analytics and metrics, and we ended up going on a journey and improving some of our outcomes in our own ICU.
And when our own ICU started having outcomes that were amongst the top in the country, the organization asked if I'd be willing to help run other ICUs. That ballooned into becoming the chief medical officer. When I was a chief medical officer, that was really involved with trying to solve some of the strife internally across departments and taking down silos. So I never started out in healthcare to be an executive. I think after the pandemic, there's times where I definitely wish I were not a healthcare executive and could go just to being back on the front line and watch them go in and save lives. There's a real beauty to the work that they're all doing and that simplicity. However, I do think that healthcare needs leaders that understand the trials and tribulations of the providers to help drive changes.
Dr. Lateef on Healthcare Administration Career Insights
CA: What have been the most fun and rewarding aspects of administration and leadership for other physicians thinking about making that transition in their career? I think we all know what's hard and frustrating about it, but tell us about the fun parts.
OL: Oh my God, you go into healthcare to make an impact. And if you're a great doctor, you're making an impact one patient at a time. If you create a program that takes 1000 transfers and one month that otherwise wouldn't have been able to have access to that level of care, you can make a much bigger impact. So it's like anything else. It has made me think about going into government. It's made me think about how do you make that broader impact? How do you get into hospital policy, healthcare epidemiology? How do you try to build systems? So the real desire in doing this is to really make an impact and make some meaningful difference, and that's I think, been the thrill.
COVID as a Catalyst for Health Systems Ongoing Transformation
CA: I would love to maybe zoom out a little bit and talk about some of the lasting ways COVID has transformed your hospital system, the way we deliver care. What do you think the lasting impacts are going to be as we look back five, 10 years from now?
OL: I'm going to tell you what I hope the lasting impacts are going to be, and I think this is really important. We started using words like health equity and people are starting to understand what it means. We start talking about access to care and people are starting to understand what that means. What's happened with COVID is it has, in front of our very eyes, highlighted what inequity does. It highlighted how inequity kills and it highlights how we have a medical system that doesn't reach all people and doesn't provide the same level of care for all people.
So what did we learn from COVID? Well, there's a couple things we learned. So one is, do we have a problem? Is there a healthcare problem in this country with equity? And the fact that we still have to debate this is a little mind numbing to me. But the reality is that early in the pandemic, we knew that in this country that has the most advanced healthcare in the world, we had three times higher mortality of black and brown people than we had of white people.
That is not okay. We have data for years. It said if you're an African American woman with breast cancer, you have a higher likelihood of dying. Yet, we still ask about hiding behind data and ask about whether or not we have a problem. So COVID taught us we have a problem, and it forced people to look at it in real time. We watched people die, unable to get life-sustaining treatments when we had empty beds in other areas. And that is not okay. The second part that COVID should teach us is it's solvable. Is it on a very small scale solvable? And I can tell you speaking from one institution in an inner city, in Chicago, we made the strategic decision to transfer patients in, who were black and brown or who were from safety net hospitals, who otherwise would not have access to the level of care we would provide.
Over a short period of time, we were able to take hundreds and hundreds and over a thousand patients in. And we found that when we did that, their outcomes were exactly the same as the outcomes of any other group, which meant that there was no genetic issue. There is no hidden problem. The problem was access to high level care. And once we provided that, we believe that this is a solvable problem.
Now, the third problem is: is it scalable. And you said, "What lesson should we learn from COVID and take forward?" Well, yes, there is inequity in healthcare. COVID proved it. Yes with COVID, we were able, once we recognize that, to change it. The third bucket is what do we do now moving forward? Chris, if we take this and go to sleep and forget about it, then a million people died for nothing in this country. Millions of people died for no reason. If we learn from this and understand that we can't have this type of a healthcare system, and we scale the solutions, which means we scale access to high quality healthcare, we won't be talking about COVID, but we will say that we've decreased the death gap in heart failure between different races. We've decreased the death gap in kidney disease. We've decreased it in cancer. And that's where we have to go. And that's the learning from COVID and anything short of that is a failure.
Rush System Health Equity Framework
CA: I think it was 2016 when Rush published your point of view on health equity in the New England Journal of Medicine Catalyst, so it was many years ago now at this point. When, and how did this become such a clear focus for you and for the system? And have the themes that you wrote about, I guess now eight years ago, changed meaningfully?
OL: So the advantage of not being smart is that I get to meet a lot of smart people and I try to learn from them and copy off of what they do. And so I had a mentor that was my predecessor, who was a chief medical officer before I became the chief medical officer, a person named Dr. David Ansell. Dr. Ansell wrote a book. He studied healthcare and equities and disparities in healthcare. And he wrote a book called The Death Gap: How Inequality Kills. And in the book, he showed that if you live on the Gold Coast of Chicago, you'll live 18 years longer than if you live five subway stops west. So just imagine the same city, five subway stops, it's almost a two decade life expectancy gap. At that point, as a researcher at Rush, we made our strategic plan to take this on. One of our pillars of our plan of Rush is we were going to provide access. We were going to take care of our community. All hospitals have a very similar strategic plan.
Only we added, we were going to drop the death gap by 50% by 2030. We don't know how we're going to do it. We just put out a bold, audacious goal and said, "This is what we're going to try to go for," or take the next 30 years, because we know this is longitudinal or take 50 years. But pick a number and pick a goal and start going to work. And that's what we try to do. We know that the drivers of that death gap are not blood pressure medicines alone. We know it's food insecurity. We know it's gainful employment. So we built strategic plans as a hospital functioning as an anchor institution, to make a difference in the lives of people other than just by providing medicine.
Increasing Access to Care Outside of the Hospital
CA: Awesome. When you think about care delivery and virtual care and remote care, and increasing access to care outside of the hospital, what gets you really excited? At Cadence, we like to think about it as your zip code shouldn't determine your life expectancy. Which technologies do you think have the opportunity to make the most impact? Which technologies are you and your team really excited to make a reality over the next 5 to 10 years?
OL: One of the most painful things that happens in healthcare is if you make a medical decision and you go to M&M and you're presenting your case, and the patient had a bad outcome and two people in the room out of 30 knew exactly what the person had, there may be an M&M bias, or maybe the fact that you're presenting there, they're looking for something that wasn't obvious, but there's always someone in the room who knew the right answer right away. And I would always leave there wishing we should have had a way for that person to give you the right answer at the right time or in real time. That's what technology does. At the end of the day, what does technology do? It brings people together.
What did a telephone do? It allows us to leverage someone else's opinion. What does a video call do? It allows us to look at somebody when we're giving it. What does technology allow us to do? Start the thrombolytics for a person having a stroke 30 miles away from a medical center that's a stroke center, by looking at a robot, looking at a machine. So Chris, you said what technology specifically? My answer is all of them. We have to continue to evolve as a healthcare infrastructure and not rely on the old school, you have to be in my room and I have to be the one to see.
There's times and we talked about that earlier, where you need to be in a room with someone. But that doesn't mean to look at some conditions. You can make a diagnosis on air and then save time and save opportunity costs and save the actual overall cost of what it takes to take care of it. So I think any technology that opens up access for people in areas where they can't get access is mission critical to improving the health of our nation. And I think that has to be our goal. And I would say what we are trying to do is have phenomenal healthcare for all people all the time. And if you say that's your goal, then you can build in ideas like open access, from very subacute televisits, to very acute at home monitoring.
CA: Well we wouldn't be more philosophically aligned. One of the things I've been really impressed by Rush is the momentum and pace that you've instilled in your team around making the future reality. What have you learned about how do you actually get things done and how do you align all the various parties across the health system to move fast?
OL: We're well on our way on a journey that a lot of brilliant people put together. We started programs like Westside United. We started programs like our Healthcare Equity Institute, and I think many other people all over the country are on the same journey. Your question is what are you doing to exploit that journey? I think one of the most honest answers to that is it's very easy during times where everybody is doing well financially to have a mission. I think what helped Rush is during a very difficult financial time, we just doubled down on our mission and that cost us a lot. And we don't know if we're going to recover from the net impact of that cost. But we lost a lot of money holding true to our mission during the pandemic. We lost a lot of money in just trying to stay true to what our cohesive goal was. I think the success that Rush had was because there was a constant reminder, and this was our mission going forward.
America’s Policymakers and Local Hospital Systems
CA: And talking about the financial aspect a little bit, you mentioned obviously Rush made tremendous financial sacrifices to be there for the community, taking in patients when it wasn't clear where reimbursement would be, shutting down elective surgery multiple times. As you think about the relationship between Rush and the community, both obviously the city and the state and the federal government, how do you think the last two years is going to shape how policymakers interact with health systems like yours going forward? How do you feel your relationships with the community have developed? And what do you want people to know about this really unique relationship in America between policymakers and our local hospital systems?
OL: We could spend the next two hours just talking about this, because it's such an emotional subject. But here's the reality: We have a very siloed healthcare system in this country, and this was challenged during the pandemic. So you could have been in a city and in that city, there's some hospitals that had no beds and other hospitals that had open beds. But patients had no access to know where to go in real time. That's a failure of our healthcare system, not of any one individual. We relied on a very overworked, underinvested public health system to break down those silos in the midst of the largest pandemic we ever had, and nobody was ever going to be able to do that.
The interaction between hospitals and healthcare policy decision makers and local government, and state government and federal government, the reality is what we learned during the pandemic is we have to have much better relationships. We have to have much better communications. We should have standing meetings. We should have frequent tabletop discussions over what happens in various disasters, so we could break down those silos and not be competing hospitals when there's a war. When there's a war, everybody has to take everybody. I think the reality is we needed our local state and federal government, one to all work together, and two to hold healthcare as an institution accountable for working together and not against one another.
CA: Dr. Lateef, this conversation has been incredibly inspiring. I think this is a great place to leave it. Thank you for taking the time. We know your schedule's really busy. From all of us here at Cadence, we look forward to continuing to follow and support all of the work you and your colleagues are doing at Rush.
Thanks again to Dr. Lateef for spending so much time with Chris this week. To make sure you get updates on our future conversations, please subscribe to Cadence Conversations, wherever you listen to podcasts. And for more information about Cadence and how to get involved, visit cadence.care. At Cadence, we believe that everyone deserves to receive the best care possible and we won't stop working until that vision becomes a reality.