Empowering Nurses Through AI Innovations with Mary Varghese Presti, SVP & GM at Dragon Medical

[00:00:08] [SPEAKER_00]: Hey everybody and welcome back to the Beat Podcast. This is Saul Marquez hosting live

[00:00:14] [SPEAKER_00]: from Los Angeles at the Vive event. Today I have the privilege of hosting the amazing

[00:00:20] [SPEAKER_00]: Mary Varghese Presti. She is the GM of Dragon Medical, an AI powered voice assistant used

[00:00:27] [SPEAKER_00]: by clinicians to document in the EHR. Mary leads the development of GenAI based

[00:00:34] [SPEAKER_00]: clinical workflows for Microsoft Healthcare and Life Sciences. She's a seasons healthcare

[00:00:40] [SPEAKER_00]: executive whose career spans nursing, policy, big pharma and big tech. Mary thanks so much

[00:00:45] [SPEAKER_00]: for joining us today.

[00:00:46] [SPEAKER_00]: Mary Varghese Presti Thanks for having me Saul.

[00:00:47] [SPEAKER_00]: Paul Hager A true pleasure and super excited to get

[00:00:51] [SPEAKER_00]: into our discussion. What are some of the biggest challenges you're seeing in

[00:00:55] [SPEAKER_00]: the nursing industry today?

[00:00:57] [SPEAKER_01]: Mary Varghese Presti What are we not seeing? First of all there

[00:00:59] [SPEAKER_01]: is just the workforce abuse situation that's going on in some settings. There's the

[00:01:04] [SPEAKER_01]: There's the higher acuity of patient load. There is the turnover. There is the cognitive burden.

[00:01:10] [SPEAKER_01]: There's the wanting to go into the profession and take care of patients but spending a

[00:01:13] [SPEAKER_01]: lot of time doing things like documentation and technology. There's a myriad of things

[00:01:18] [SPEAKER_01]: that are going on but I guess at the end of the day the biggest problem is the shortage

[00:01:22] [SPEAKER_01]: and we're at a crucible moment right now in the industry because nurses are leaving.

[00:01:25] [SPEAKER_01]: They're leaving for a lot of different reasons and it's really important to get under

[00:01:30] [SPEAKER_01]: figure out how we're going to solve it because we are all going to be either current or future

[00:01:35] [SPEAKER_01]: patients at some time and we need to make sure that there's a nursing force there

[00:01:38] [SPEAKER_01]: to take care of us.

[00:01:39] [SPEAKER_00]: Paul Hager Totally. Yeah it's a big issue and it hasn't

[00:01:42] [SPEAKER_00]: gotten better since the pandemic has ended. It's actually gotten worse. Can you explain

[00:01:47] [SPEAKER_00]: how Microsoft and Nuance are developing a solution tailored to nurses and their

[00:01:54] [SPEAKER_00]: specific needs and how AI plays a role in that?

[00:01:57] [SPEAKER_01]: Yeah so just to go back to the point you just made. It's not getting better but more

[00:02:01] [SPEAKER_01]: people entered nursing school as a result of the pandemic. So we're actually

[00:02:06] [SPEAKER_01]: graduating nurses. It's just that after a short period of time they leave.

[00:02:12] [SPEAKER_01]: So I think that's really interesting because the pandemic burned out a lot of

[00:02:16] [SPEAKER_01]: people but it also inspired many to go into the profession. We have a long

[00:02:20] [SPEAKER_01]: history in terms of supporting clinicians with their workflow really using voice.

[00:02:24] [SPEAKER_01]: So Dragon is an iconic brand. It's been around for decades. There's really not a

[00:02:29] [SPEAKER_01]: physician you can find who hasn't used it at some point and so we really honed

[00:02:33] [SPEAKER_01]: our craft around the accuracy, the voice capture to the point where physicians

[00:02:38] [SPEAKER_01]: are using it as a third hand every day during their day to document in a

[00:02:42] [SPEAKER_01]: way that is an experience that they can get through so that they can

[00:02:45] [SPEAKER_01]: actually get home to their families. When we think about doing that for

[00:02:49] [SPEAKER_01]: nursing, they share the same arc of burnout but the way that they document

[00:02:55] [SPEAKER_01]: and the way that they work are very different from physicians. So nurses we

[00:02:59] [SPEAKER_01]: believe they need to be hands-free, they need to be eyes-free, they're on

[00:03:02] [SPEAKER_01]: their feet, they're constantly talking to patients,

[00:03:05] [SPEAKER_01]: comforting them, observing them, evaluating them, helping them up. So this

[00:03:10] [SPEAKER_01]: is just a part of their day to day and so how do you actually bring

[00:03:13] [SPEAKER_01]: something that is meaningful enough for them to use because the standard to

[00:03:17] [SPEAKER_01]: use is paper. You see it all the time, they're writing on paper still even

[00:03:20] [SPEAKER_01]: though there are systems that we all have in terms of records, electronic

[00:03:24] [SPEAKER_01]: health records and if it's not paper it's on their hand, it's on their

[00:03:27] [SPEAKER_01]: scrubs and so they're just incredibly busy and they always put the patient

[00:03:31] [SPEAKER_01]: first and what's happening more and more is that there's a book of

[00:03:34] [SPEAKER_01]: activities and tasks that are coming in between that and so the way that

[00:03:38] [SPEAKER_01]: we're looking at it and really with the advent of these advanced

[00:03:42] [SPEAKER_01]: generative AI and these more advanced large language models, it's really

[00:03:46] [SPEAKER_01]: broken open the capabilities that we have now to use technology to solve

[00:03:50] [SPEAKER_01]: these problems but the magic is understanding exactly what is the use

[00:03:55] [SPEAKER_01]: case that's going to make a difference for the nurses.

[00:03:57] [SPEAKER_00]: Thank you for that, yeah there's big opportunity, you really call out some

[00:04:01] [SPEAKER_00]: very real examples of how we could help nurses with this and looking

[00:04:05] [SPEAKER_00]: ahead, how can organizations ensure that nursing technology with AI is

[00:04:10] [SPEAKER_00]: implemented in an intentional responsible way?

[00:04:13] [SPEAKER_01]: First of all, nurses have to be at the table and they have to be at

[00:04:16] [SPEAKER_01]: many different tables. I think for a long time they've been this lost

[00:04:20] [SPEAKER_01]: workforce where we expect everything of them but we put them last when it

[00:04:24] [SPEAKER_01]: comes to investments and technology plays and so I'm super excited to see

[00:04:28] [SPEAKER_01]: the space that we're in right now and they say necessity is another

[00:04:31] [SPEAKER_01]: invention but we are starting to see a lot of change across health

[00:04:34] [SPEAKER_01]: systems in terms of the way that they're prioritizing budget or really

[00:04:38] [SPEAKER_01]: trying to figure out what they can do to innovate around what they

[00:04:41] [SPEAKER_01]: would say is their nursing crisis. Like I said, first of all they have

[00:04:44] [SPEAKER_01]: to be at the table. Second of all, Microsoft is the leader in really

[00:04:47] [SPEAKER_01]: laying out a framework around responsible AI. The rigor at which we

[00:04:51] [SPEAKER_01]: have to go through before we can launch an AI product is exceedingly,

[00:04:55] [SPEAKER_01]: it's a very high bar. So whether it's inclusiveness, fairness,

[00:04:59] [SPEAKER_01]: transparency, security, privacy, there is a very significant set of

[00:05:05] [SPEAKER_01]: checks and processes from testing to bias, all of that we have to

[00:05:08] [SPEAKER_01]: go through and we do that with our clients, with our development

[00:05:12] [SPEAKER_01]: partners. So I think it's really important to ask good questions, I

[00:05:15] [SPEAKER_01]: think it's important to know where you're quote unquote buying your AI

[00:05:19] [SPEAKER_01]: from because we are in this new era and we're just at the

[00:05:22] [SPEAKER_01]: beginning of it. There's tons of promise but we have to really

[00:05:26] [SPEAKER_01]: approach it with a pragmatism in terms of developing it the right

[00:05:30] [SPEAKER_01]: way, developing it so there's real utility and for us we are very

[00:05:34] [SPEAKER_01]: focused on adoption because I think you can create the best product

[00:05:38] [SPEAKER_01]: in the world but if it's not going to get used, if it's not

[00:05:40] [SPEAKER_01]: going to get adopted, it's going to sit there and so we spend a lot of

[00:05:43] [SPEAKER_01]: time thinking about what are the ways in which we need to develop

[00:05:46] [SPEAKER_01]: it? What are the ways in which the experience has to be creative

[00:05:49] [SPEAKER_01]: to the nurse's day to make it a solution that they're going to

[00:05:51] [SPEAKER_01]: adopt and see meaningful use out of.

[00:05:54] [SPEAKER_00]: Yeah, now some great points there from adoption to getting into

[00:05:58] [SPEAKER_00]: it with a very clear framework, right? The different things that

[00:06:02] [SPEAKER_00]: you need for ensuring that technology is going to be responsible

[00:06:05] [SPEAKER_00]: across the different things that you mentioned is critical. Can you

[00:06:08] [SPEAKER_00]: share some of the most exciting technological innovations you

[00:06:12] [SPEAKER_00]: believe will significantly improve patient care and outcomes?

[00:06:16] [SPEAKER_01]: Yeah, so first of all in the United States, in our health care

[00:06:19] [SPEAKER_01]: system we have what I would say ultra high technology medicine

[00:06:24] [SPEAKER_01]: but where I think there's a lot of opportunity is really

[00:06:27] [SPEAKER_01]: applying innovation around the provision of care and that is

[00:06:30] [SPEAKER_01]: really focusing on the providers because if you can really

[00:06:33] [SPEAKER_01]: support them and transform the way they deliver care then you

[00:06:36] [SPEAKER_01]: elevate the patient experience for everybody and you drive

[00:06:39] [SPEAKER_01]: quality outcomes. We've seen a lot of effort around

[00:06:42] [SPEAKER_01]: physicians and this is an opportunity now to really think

[00:06:45] [SPEAKER_01]: about the nurses and from that other members of the care

[00:06:48] [SPEAKER_01]: teams as well. So one of the areas I'm super excited about

[00:06:51] [SPEAKER_01]: is what we've seen around virtual nursing. So you see

[00:06:53] [SPEAKER_01]: nearly every health system experimenting, innovating or

[00:06:56] [SPEAKER_01]: going at scale with different platforms that are about

[00:06:59] [SPEAKER_01]: bringing that experienced nurse back into that room in a way

[00:07:02] [SPEAKER_01]: that is preferable for them, right? They left the bedside

[00:07:05] [SPEAKER_01]: but they have tons of experience to bring and really in

[00:07:08] [SPEAKER_01]: every other industry we've gone remote. So you're seeing that

[00:07:11] [SPEAKER_01]: change, you're seeing different units try different things

[00:07:14] [SPEAKER_01]: and really change the model of nursing care delivery because

[00:07:18] [SPEAKER_01]: in some units it might be we want that nurse to really

[00:07:21] [SPEAKER_01]: do a preceptorship through virtual because we have on

[00:07:24] [SPEAKER_01]: average most of the nurses that are actually at the

[00:07:26] [SPEAKER_01]: bedside these days have less than three years of

[00:07:28] [SPEAKER_01]: experience. So here's the way to bring partner that nurse

[00:07:31] [SPEAKER_01]: up with very experienced nurses. Then there's the whole wow

[00:07:34] [SPEAKER_01]: admission and discharge, it's very time consuming. You

[00:07:37] [SPEAKER_01]: really need to be thoughtful, you need to be very

[00:07:39] [SPEAKER_01]: engaged and you need to have the ability to do that

[00:07:42] [SPEAKER_01]: without interruptions. Is that a piece that we could

[00:07:44] [SPEAKER_01]: do remotely so that the nurses on the floor can focus

[00:07:47] [SPEAKER_01]: on other things? So you see a lot of experimentation

[00:07:50] [SPEAKER_01]: in terms of how might we augment the way that

[00:07:52] [SPEAKER_01]: nurses are staffed and the way that they go through

[00:07:55] [SPEAKER_01]: their shift and they're all doing it differently and

[00:07:57] [SPEAKER_01]: they're all finding different ways to find ROI and I

[00:08:00] [SPEAKER_01]: think that's wonderful. I think that's going to bleed

[00:08:02] [SPEAKER_01]: into more and more technologies that also start

[00:08:05] [SPEAKER_01]: going into that intersection between that patient

[00:08:08] [SPEAKER_01]: and the provider and also between the provider, the

[00:08:11] [SPEAKER_01]: physician and then the nurse and also between the

[00:08:13] [SPEAKER_01]: nurse and the broader care team. As we start

[00:08:15] [SPEAKER_01]: getting into those areas with more investments in

[00:08:17] [SPEAKER_01]: technology I think that's where really the

[00:08:20] [SPEAKER_01]: provision of care not necessarily the high tech

[00:08:23] [SPEAKER_01]: medicine that we all do have in this country

[00:08:25] [SPEAKER_01]: but that provision of care is actually going to be

[00:08:27] [SPEAKER_00]: transformational. Love that. Yeah I think it's very

[00:08:29] [SPEAKER_00]: promising and the different angles that you shared

[00:08:32] [SPEAKER_00]: could really be beneficial to a lot of the nurses

[00:08:35] [SPEAKER_00]: that are practicing today. Artificial intelligence

[00:08:37] [SPEAKER_00]: and machine learning are buzzwords in healthcare.

[00:08:41] [SPEAKER_00]: In what ways do you see these technologies making

[00:08:44] [SPEAKER_00]: a tangible impact both on providers and patients?

[00:08:47] [SPEAKER_01]: AI has been around for quite some time. Dragon

[00:08:50] [SPEAKER_01]: Medical is AI, it's voice powered. I think that

[00:08:53] [SPEAKER_01]: what we're going to see in the future because

[00:08:55] [SPEAKER_01]: we are in this very beginning of this era is

[00:08:58] [SPEAKER_01]: we're going to, it's going to be ubiquitous. We

[00:09:00] [SPEAKER_01]: are going to see co-pilots for all sorts of

[00:09:03] [SPEAKER_01]: different roles to do all different things. But

[00:09:05] [SPEAKER_01]: I think that some concerns around AI is going

[00:09:07] [SPEAKER_01]: to take jobs. I think the really the way that

[00:09:09] [SPEAKER_01]: we've all adapted around technologies today

[00:09:12] [SPEAKER_01]: right whether it was the internet or mobile

[00:09:14] [SPEAKER_01]: or social media is it changes the way that you

[00:09:18] [SPEAKER_01]: work. So with AI I think you can pick off

[00:09:20] [SPEAKER_01]: certain tasks and then augment the person

[00:09:22] [SPEAKER_01]: doing those tasks so that person can actually

[00:09:24] [SPEAKER_01]: focus on perhaps different things that they wish

[00:09:27] [SPEAKER_01]: they could be doing if they weren't doing

[00:09:28] [SPEAKER_01]: these other things that might be a little bit

[00:09:29] [SPEAKER_01]: redundant or could be automated. So I think

[00:09:32] [SPEAKER_01]: those are all great opportunities. I do think

[00:09:35] [SPEAKER_01]: that we see voice as the new user interface

[00:09:38] [SPEAKER_01]: we think with ambient, with all of these

[00:09:40] [SPEAKER_01]: technologies where you can just speak. That is

[00:09:43] [SPEAKER_01]: a tremendous way to really think about AI

[00:09:45] [SPEAKER_01]: changing sort of the way that you go

[00:09:47] [SPEAKER_01]: through your day. When the Microsoft Suite

[00:09:49] [SPEAKER_01]: co-pilot's now being rolled out and it's

[00:09:51] [SPEAKER_01]: great. You can choose to use it. I choose

[00:09:53] [SPEAKER_01]: sometimes to use it. I choose sometimes to

[00:09:54] [SPEAKER_01]: turn it off. I choose to see as a bake

[00:09:57] [SPEAKER_01]: off. Do I like that better or not? But it's

[00:09:58] [SPEAKER_01]: augmentation. It's an assist. But I think we

[00:10:01] [SPEAKER_01]: all could benefit from that.

[00:10:03] [SPEAKER_00]: Love it, Sed. We definitely can all benefit

[00:10:05] [SPEAKER_00]: from these new technologies in our day to

[00:10:08] [SPEAKER_00]: day and especially health workers. I really

[00:10:11] [SPEAKER_00]: can't thank you enough, Mary, for spending

[00:10:13] [SPEAKER_00]: some time with us sharing the insights that

[00:10:15] [SPEAKER_00]: you and the Dragon and Microsoft team have.

[00:10:17] [SPEAKER_00]: What closing thought would you want to

[00:10:19] [SPEAKER_00]: leave the listeners with today?

[00:10:21] [SPEAKER_01]: I guess I would say be open. We are really

[00:10:23] [SPEAKER_01]: in this amazing time. We don't know what's

[00:10:26] [SPEAKER_01]: going to be but I think it's safe. We all

[00:10:27] [SPEAKER_01]: put our heads together and make sure that

[00:10:29] [SPEAKER_01]: we're focused on the right problems. I think

[00:10:31] [SPEAKER_01]: we're going to come out ahead.

[00:10:32] [SPEAKER_00]: Thank you for that and certainly excited

[00:10:34] [SPEAKER_00]: to see what you and the team do to give

[00:10:36] [SPEAKER_00]: us a bright future. Thanks, Mary.