Dr Amar Gupta, Prof. Computer Science & AI Lab at MIT, Joe Kristol, Senior Advisor to Chairman at United Hatzalah, George Matthew, CMO at DXC Technology at Converge2Xcelerate Conference (Boston, MA)
- DXC Technology generates $20.8 billion in annual revenue
- United Hatzalah is a non-profit emergency medical service organization based in Israel
- Goal of United Hatzalah is to reduce deaths related to ambulance delays
Dr. Amar Gupta – Prof. Computer Science & AI Lab, MIT: 00:00
Welcome to the session. Because we are trying to catch up on time, you’re going to minimize some of the time for the session. I’ve spent most of my life at MIT. I’m going to be the moderator for the session and we’re going to let my colleagues go ahead and introduce themselves and present the material which we are going. Can we go to the next slide please? There’s one more slide. So here is a big laundry list of things which happen when you’re trying to apply something, deploy something. We’re going to use this as the list for Quicklinks to go ahead and mention things about what has happened in the respective environments and Joe do you want to start.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 00:54
Sure. So Joe crystal. As you heard earlier from Tory, I work for the chairman and founder of a nonprofit called United Hatzalah. Do you want me to turn my mic off or on? Anyway, so my background, I was a Marine infantry officer for four years. Got out of the Marines, went to McKinsey as a consultant up in New York. Left McKinsey to go work on Capitol Hill. And then about six months ago, I joined Mark Gerson, who’s the chairman and cofounder of United Hatzalah in New York working on both, expanding the presence of United Hatzalah in the United States under the name United Rescue and some other projects. Okay, so turn over to introduce yourself
George Matthew – CMO, DXC Technology: 01:59
Hi, I’m George Matthew. I’m the chief medical officer for DXC technology. We’re a 20 plus billion dollar it vendor. Three and a half of that’s in healthcare. I cover the America’s North and South most of our businesses in Medicaid, but we also do payer, provider and life sciences. I’m also an internal medicine physician. I practice part time at a local hospital, five minutes away from my home. Nice to meet everyone.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 02:27
So you all chose the right room to be in because I’m actually going to show a very short video, which I think will be a fun way to energize after lunch. If it’s possible to click to the next page. So this is a video that went viral made by an Israeli Arab video blogger. It really describes what United Hatzalah is. You can turn the volume on. Okay, I’ll read along with the subtitles that are volume is very gripping. All right, so I will narrate. So basically, Hatzalah was founded in 2006 by led beer. This gentleman who’s speaking right there who is an EMT in Jerusalem and basically identified a problem, which is people die every day waiting for an ambulance that should be able to arrive and save the patient’s life. And the ambulance often gets stuck due to traffic, congestion, narrow streets you know, all sorts of other issues. And so what’s the way we can solve this? Well if we can train people in the community, equip them with the right medical gear and give them the knowledge of a medical emergency happening around them, we can crowdsource first response in a rapid manner to get there far before the ambulance could ever arrive.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 04:16
So Israel, like many other Western countries has, you know, 10 plus minute ambulance response times obviously varies a bit by geography. The United Hatzalah volunteers. Now, you know, almost 15 years later, there’s 6,000 trained and equipped volunteers all across the country. The average response time for those volunteers is three minutes in metropolitan areas. The average response time is 90 seconds. And now the next sort of goal for the organization is to get to a 90 second response time across the country. Now Israel system is bit different than the United States is there’s not a centralized now one system. And so one of the things that’s been interesting for me is I’ve joined the organization is learning how to apply this to the United States. One thing I should note, and again, if you could hear the volume and in the video you would be able to see this a bit easier, but it’s totally nondenominational.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 05:14
You know, one of the amazing things about this organization is it’s brought together Jews and Arabs and Christians, men and women, old and young, you know, the volunteers truly represent the diversity of the state of Israel. And you know, it’s brought people together around just sort of a common purpose of saving lives. So in the United States about four years ago, we launched what we call United rescue. Hatzalah means “rescue.” And we launched that in Jersey city and sort of get into the theme of these, of this panel around innovation barriers. You know, the reason that we were able to launch in Jersey city is that we had the leadership, frankly, of the mayor there, a man named Steve Philip who, when he met with my boss and heard about the program, said, all right, we’re going to do this.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 05:59
And if my boss were here the way he would describe it. As, you know, he’d heard that sort of, we’re going to do this from many different politicians before, but Steve Phillip was the only one who actually responded the next morning with an email saying, all right, I’ll talk to my head of EMS. I’ve talked to the hospital, talked to police, talk to fire. Like what are the next steps as a lot of credit to the political leadership there, because you know, anything that involves entrenched bureaucracies like EMS, fire health systems, a 911 data, there’s a lot of nervousness around, you know, breaking that system or even innovating around the margins. And so what we do is we don’t, we’re not trying to replace, you know, professional responders. We’re simply adding another layer of response. And the way it works in Jersey city is that we’ve integrated with an all in one system.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 06:42
So when you call 911 in Jersey city, if you, God forbid somebody ever has to do that in this room or know somebody who does or has, but you know, the 911 dispatch center will both dispatch a United rescue volunteer. You can stop the video. Now police they’ll both dispatch a United rescue volunteer as well as the, you know, BLS or ALS ambulance crew. And so we’ve now trained in the last four years about 200 United rescue volunteers across Jersey city. They represent the entire community much like they do in Israel. And you know, the way it works is they have an app on their phone and when they’re nearby the scene in emergency, they get dispatched and they bring their medical equipment, they drop whatever they’re doing and they get to the scene beating the ambulance over half the time.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 07:30
Now getting back into the theme of the talk you know, Jersey City, we had the political leadership. It was able to allow us to get in there in the first place. Unfortunately, one challenges is that they’re actually really good at doing it emergency response as it is. And so their average response times, unlike most other cities is already a impressive five minutes. And so it’s made it harder for us to really prove the value of having this sort of crowdsourced system of adverse response. But even that really rapid 500 response time, which they’re able to achieve through a lot of interesting, you know manner and pre-positioning ambulances and moving ambulances every few minutes based on, you know, real time data. We are still able to beat those ambulances over half the time. So we’ve, in the last, literally two months ago, we launched our second chapter further up North in Jersey in a town called Englewood in Bergen County.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 08:22
Again, you’re, the reason we chose Englewood was not necessarily that was the best use case for United Rescue, but it was because the number two EMS director in Jersey City took go over the top job in Englewood. And when he got there, he said, I want to bring United Rescue with me. So for us that was really fulfilling to hear that, you know, this wasn’t something that the mayor, I mean initially it was something that the mayor forced down the throats of the EMS leadership. But by the time, you know, they’d grown up in the program and seeing it effective saving lives even the EMS leadership who were, you know, naturally sort of averse to the idea of bringing a bunch of volunteers to disrupt their operations. We’re eager to bring it to other cities, you know, in this case Englewood. And the next thing we’re working on and you know, haven’t talked more about, I don’t want to go on too long, is we’re, hoping to pilot in New York city sometime in the near future.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 09:09
We’re currently, you know, we then had many talks with FDNY and which controls EMS in New York had some support from members of Congress, which has been helpful to a point. They obviously don’t control local issues in New York. And we’ve had some real support from some of the big real estate companies in New York who want to pilot this in their buildings. And so our hope is that we might be able to bypass my one system as initial proof of concept to show that we can dramatically reduce vertical response times, which is obviously a huge problem in New York. And get volunteers to provide basic, you know, CPR, norcan administration, EpiPens, kind of the basic you know, level of response. They can still save lives when, when every minute and second counts.
George Matthew – CMO, DXC Technology: 10:03
You know, I mean when I look at this and we can start going through some of the various deploy to deployment versus innovation. Again, I just wanted to kind of commend some of the work you all are doing from the research I’ve been doing, which is just basically existing health care systems in the US and abroad. What you’re describing I think is really the future of healthcare where it’s going to go. We are already seeing kind of a fragmentation of healthcare where the price is going up, the access is going down and people still need the care. The demand hasn’t gone away. Being able to distribute it this way is amazing. But you’ve also highlighted a couple of the barriers that we’ve actually got on the list in terms of just because it’s a good idea and it’s a great innovation can save lives; doesn’t necessarily mean it’s going to be implemented.
George Matthew – CMO, DXC Technology: 10:48
And I think even some of the stories that you were telling us about pointing out gaps in the system, even when it’s glaringly obvious, there’s still a resistance or an inertia to actually making those changes. And one of the things we thought would be good would be to go through by identifying those barriers and then maybe talking about some anecdotal experiences we’ve had. We may not have all the solutions, but part of the path forward would be to identify what those barriers might be and then tactically figuring out how to bring people together to solve those, those barriers.
Dr. Amar Gupta – Prof. Computer Science & AI Lab, MIT: 11:22
Specifically the area I’d like you to touch upon is that when you’re telling it Israel and all these people’s medical records are spread across all over the country, when a person comes in, does he or she have access to the previous information of the patient, how do you retrieve it, how you’re doing it in Jersey, given all the dichotomy. That’s one area which is there. The other is how is it financially being mad, who’s paid for it? Those are kinds of things in terms of scaling up, that’s what likely to cover.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 11:47
Sure so, I’m more familiar with the US in the medical records side of things. In the US in w we’re really just in general, we’re always subject to the local jurisdiction in which we operate. So Jersey city and Englewood are probably, you know, 20 minutes apart, but they have different EMS systems. You know, Jersey city falls under the pretty large RWJ medical system. Englewood falls under the private hospital called Englewood health. And so for better or worse, we are learning to adapt our model to the different needs and requirements of each municipality. Both in terms of what level of training we provide. What level of certification we’re required to provide to New Jersey. For example, we train our volunteers to an EMR certification, which is an emergency medical responder, which is just short of an EMT. And you know, we’re in talks and in Englewood, we actually haven’t been operational yet.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 12:45
We’ve just started training our first class of volunteers. But we’ve been talks about different ways to share medical record data because these are the same problems that the EMS crews already faced in terms of, you know, what access do they have to medical records when they arrive on scene and, and afterwards. On the funding question, I know that this is a little bit not the weeds on that, but it’s basically, it depends, is the simple answer on the funding front, you know, we provide our services totally for free. And one of the challenges we have in terms of scalability is the business model. So, you know, in Israel it’s meant to be a free service provided to anyone. It’s funded mostly by individual donations, some grants and institutional giving as well. But we have no aspirations to start charging for our services by any means. In the US it’s the same model, but we’re being very deliberate in making sure that wherever we launch in the US can be self-funding in the community in which we operate.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 13:51
The good news is we’ve really managed to keep it lean operation. Biggest costs are training equipment, you know, an AED, which all of our volunteers carry costs, I think $1,200. We pay a little bit to help dispatch actually dispatch our volunteers. And then there’s the technology integration costs and some sort of startup costs as well. But basically, you know, it’s pretty cheap and I think the analysis we did in Jersey is that, you know, it’s like less than a dollar per citizen can fund the program for a year. And so Jersey’s about, I think it’s just, it is a little bit more than 200,000 citizens in Jersey city. And that’s basically the budget. It’s about $200,000 per year to keep 200 volunteers responding to about a hundred calls a week every week and saving lives. So as we look to New York, again, because we’re thinking about this vertical response within some of these big buildings, the city you know, we’re looking at corporate partnerships.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 14:55
How can this become a service perhaps that, you know, you work in a 30-story office building. And it’d be nice to know that if, if God forbid somebody or yourself or someone in your colleagues, whoever had an issue that you wouldn’t have to wait 15 minutes for an ambulance to both battle Midtown traffic in Manhattan and then get to your building, go in the door and realize the elevators aren’t waiting for you and have another seven minutes to get to your actual floor. But meanwhile, there could be a doctor literally, you know, a floor away if not a couple offices away on the same floor, but they don’t know that you’re having an issue and there’s no coordination whatsoever. And so we hope that this can even be a perk that, you know, sort of a real estate providers might think of providing to their tenants. So that’s one way we’re looking at to make it sustainable.
Dr. Amar Gupta – Prof. Computer Science & AI Lab, MIT: 15:37
Okay. And the cost which you provided included a cluster providing insurance to all these volunteers.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 15:42
So amazingly we take advantage of the good Samaritan laws. And so that keeps our liability insurance low. We don’t, we don’t use, you know, we have one vehicle and towards the city, but it’s more of a training vehicle than anything. We don’t allow our volunteers to, you know, put lights on their cars and sort of blow through a red lights as much as many of them really want to. We have to restrain that a little bit. So yeah, you know, knock on wood, we’ve never had an incident in four years responding to thousands of cases at this point. Saving many lives. We just, we just haven’t had an incident so we hope to keep that obviously up. But in the event, we do, we’re coming out of the hospitals that we partner with a pretty modest liability insurance policy.
George Matthew – CMO, DXC Technology: 16:25
I mean, a lot of what we’re doing now in blockchain is you know, consent as a service and trying to figure out how you know, folks can actually use blockchain is the fundamental basis of data sharing and data interoperability and actually monetization. And some of the schemes we’re looking at in a say schemes in the nicest way possible. We’re looking to see if we can give patients control over their data so that they can decide not only who gets it, but if they want to charge for it and use it as a way to potentially self-fund their own healthcare. Now obviously we’re not talking a ton of money, but then again, this is the very beginning or early innings of the model. One of the challenges we’ve seen with blockchain. That’s why I really like the example you’re giving Joe, is that when it first came out and many of you have had the similar experience, it looked like a solution looking for a problem.
George Matthew – CMO, DXC Technology: 17:18
You know, it’s a very interesting, elegant model, but it, at least for the first couple of years it seemed in healthcare people were like, well, we could apply up to provider verification, we could maybe apply it to interoperability, we do declaims processing. And so a lot of test cases were funded over the last couple of years. And I think when I was at Hashed Health last year, what seemed to be the conclusion was, okay, we funded these test cases. You can do it, but I’m okay with what I got now. Why am I going to change that? I’ve invested a ton of money in my old rickety claims processing system. I already have a set of standard operating procedures for provider verification. So it starts to get a little squishy because there seem to be fewer and fewer cases that it applied to. But I think the good thing about it is it does seem to be tailor made for certain cases where you want a decentralized health system, so if you want to have something that doesn’t have to have one source of truth but rather has multiple nodes that would check it.
George Matthew – CMO, DXC Technology: 18:21
And again, I think interoperability is actually a good example for it. The data monetization and ownership, it seems to be another and more starting to slowly filter up. We are starting to see that and that’s what we’re researching. Now. What I like about this model quite honestly is that you haven’t mentioned blockchain once, which is great. It’s a distributed decentralized model that actually democratizes how you deliver care to folks cause you’re training people up to the point where they know how to resuscitate and maintain someone until they get to higher level of care. And you didn’t mention blockchain cause unless you’re talking about data exchange, but you really don’t need to worry about it. But that idea of kind of like getting rid of the central core so you can actually be more efficient and scalable. That’s interesting.
George Matthew – CMO, DXC Technology: 19:07
And that’s something that I’m also trying to see whether we need blockchain not at all to support that type of model because in a lot of cases you don’t maybe when it gets farther along, more sophisticated, maybe our financial model kicks in. Yeah, there might be a use case for it. But this in a lot of ways, on the one hand it is a distributed decentralized model, but then like any other innovation, you got to go through all this. You got to get buy in from folks internally. They have to be willing to actually go through the process of change. I think one of the things you mentioned is the fact that you try to build it within the locale itself. That’s also one of the key change management principles of trying to have end users who have to use the system, build the solution themselves so they have instant buy-in versus having to like try to take something else that someone gives them and then trying to make it, you know, a square peg fit into a round hole. So there’s a lot of key things that you’ve mentioned that I think actually talk about solutions to some of these barriers.
Dr. Amar Gupta – Prof. Computer Science & AI Lab, MIT: 20:06
Just to place it in perspectives. If you have systems which are hierarchical, one organization-wide, one system wide, then you can go ahead and do things which have much greater degree of symmetry and synthesis. Once you start dealing with different vendors, different systems and all, that’s where you get into issues of authentication or being able to take the patient number and all. That’s where blockchain comes in. And then furthermore, when you have all the different instances semantics itself or how that information is represented, then you have to go through things beyond blockchain or as a compliment to blockchain. That’s roughly what it is. So some of the issues which have come up I should tell you in their cases as well as other cases, 500 years ago there was a philosopher by the name of Machiavellian and how many of you had heard of word Machiavellian?
Dr. Amar Gupta – Prof. Computer Science & AI Lab, MIT: 20:55
Okay. So basically he said that the people who are there who are already using the system, they want the status quo to continue and therefore they will put all the pressures for the status quo to continue. And the people who are going to benefit from the new system, they are not there to help you. So therefore they are not present to do it. So you really, anybody who’s wanting to make a change on it has to face lots of different resistance. And again, it’s a thankless job for many people. So in my life, there have been many times where people have talked to me about implementation, what should be done to implement? I’ve had only one person in my entire life. He was my doctorate supervisor at MIT who taught me how to do counter implementation. That if you don’t want things to change, what should you do it. And that’s one of the lectures. I do not want to give an agenda, don’t give what is content politician, but I actually find it in Whoa, even without people being formally taught on it, how they go ahead and implement things to count implemented and not make change to take place. So again, unless they want to say something more, I want it to be an interactive discussion. I like to welcome questions from you so that we can take it. That’s the way I’d like to run this panel. Any questions you have? Go ahead. Please stand up and just identify yourself and just say your name and organization please. Yeah,
Speaker 1: 22:05
I just wanted to ask Joe cause you bet the volunteers and what happens to the FDNY.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 22:10
Totally. So it’s funny you say that. So the biggest concern that FDNY gave us after a very positive first few meetings where we gave them a ton of data about how we’ve been operating Jersey city. And you know with the supportive Congressman max Rose from Staten Island who also pilot business district was, you know, our lawyers identified one major issue. And that’s what if the volunteers get in people’s houses and apartments and they steal something. And you know, my boss, his head almost exploded because she said, you know, it is real. That’s not a problem. Nobody would ever asked that question. It’s kind of insulting. But sure. So, and you know, is true. There’s some cultural differences between Israel and us, which, which we have to be aware of. And it’s been a learning process for all of us. But we do vet our volunteers.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 22:52
They get a background check, they do all the injuries. The city in Englewood, we partner with the hospitals there and they’re technically hospital volunteers. So they go through the exact same process you would do if you were, you know, pushing wheelchairs or doing something else in the hospital itself. But they got a background check. They get interviewed by the EMS director who doesn’t work for us. They have to get various medical tests and so on. And then we say, look, you know, the risk of our volunteers about the same as the risk of a professional firefighter EMS person doing something bad. And hopefully that never happens. But if you’re so risk averse that you’re worried about it, then we’re probably not the ones for you. Unfortunately. You know, I learned today that you’re from Detroit before I joined organization, Detroit was the furthest we’ve gotten with the city that said, no, unfortunately.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 23:37
And we spent about a year getting to the finish line and the last minute the mayor basically asked a question, what if something goes wrong? It sort of goes back to the insurance question before and our answer was, you know, good Samaritan laws, liability insurance. But if you’re asking us to guarantee that a volunteer will, you know, somebody will die under the care of a volunteer because that’s what happens in medical emergencies. We can’t give you that guarantee. Unfortunately, the mayor said no. And it’s unfortunate for many reasons, Detroit would have been an amazing place to partner because, and I’ve heard this secondhand from my colleague.
Joe Kristol – Senior Advisor to Chairman, United Hatzalah: 24:12
When we asked the Detroit leadership, what are your ambulance response times today, they said 10 minutes to never. And so imagine us being able to come in and get two, three minute response times where we’re training people in the community, in Detroit, particularly in areas in Detroit where the reason it’s never is that ambulances won’t go there. And so, you know, again, in Jersey city we have a really diverse set of population who’ve been trained, equipped, and able to respond to emergencies. And you know, it’s not just in the high rises along the Hudson river. It’s all across the community. But it’s certainly important that I didn’t mean to make, make light of it, but it’s a challenge that people have certainly identified.
Dr. Amar Gupta – Prof. Computer Science & AI Lab, MIT: 24:53
Okay. Alright. Thank you very much.