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Becker’s Healthcare Podcast
Intelligent Health and Empowering People Through Data and AI with Dr. Nasim Afsar
00:22:55
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- [00:00]
A
This is Scott Becker with the Becker's Healthcare Podcast. I am thrilled today to be joined by a brilliant physician leader. We're joined today by Dr. Nassim Afsar and Dr. Avsar has written a new book. She's had a brilliant career and we'll talk about that before we get started on what you're doing today and so on. Can you take a moment to introduce yourself and tell the audience a little bit about your career and your brilliant career, quite frankly.
- [00:30]
B
Thank you so much, Scott. I'm thrilled to be here again with you to talk about my new book, Intelligent Health. I am a physician by training and background. I trained in internal medicine and was on faculty at UCLA Health as a hospitalist for over a decade taking care of acutely ill patients. But really got into healthcare administration early on in my career. And kind of the force behind that, Scott, was I became a physician because I wanted to make sure that we were creating and innovating to make large scale impact. My way of doing that was by being at bedside, integrating all the information that an acutely ill person had and trying to work with a talented team of physicians, nurses and staff to figure out how we can help that person transition towards healing. Well, when I started to see the gaps that we had in healthcare at the beginning of my career, became very interested in how do we actually build more robust systems of health and care. And got into the C suite at UCLA as their kind of inaugural Associate Chief Medical Officer, which was, this was in the early days. So this was the chief, the chief Quality Officer of two decades ago before we kind of had a title for that. And I went from bedside, where I was taking care of 20 people, to now thousands of people through our quality work at ucla. I was then asked to take on a broader role in population health management. Helping people get better health and care from birth through the transitions at the end of life gave me an opportunity to care for hundreds of thousands of people. Became very interested in how do we actually finance and move things forward in an effective way that's sustainable for the long term. Got my MBA and became a Chief Operating Officer at UC Irvine Health, where again, I now had an opportunity to impact millions of people. And then my very first CEO, one of my wonderful friends and mentors, David Feinberg, recruited me to Cerner as their inaugural Chief Health Officer with the idea that technology is our most powerful lever to be able to advance health and care across the globe. And we had over 300 million people across the globe who counted on our technologies for better health and care. Well, you know the story with that. Got acquired by Oracle within six months of me joining, and then Oracle retained me as their chief health officer. And at Oracle, I got to work with healthcare delivery systems across the globe, but also major payers, pharma, medtech, pharmacy, retail, food and beverage companies. Scott, because as you know, everyone is trying to figure out how do we kind of leverage technology to get the health outcomes that we need as well as create operationally and financially sustainable organizations. Love that position. Transitioned out about a year ago to. Right. Intelligent Health, which is kind of the evolution of where I've come. Where my focus is really on how do we leverage these technologies to empower the consumer of health and care to thrive. That brings us today.
- [04:02]
A
Thank you. Thank you. So you've worked at these major institutions, from UCLA Health to Oracle Cerner, and now your focus is now the new book, Intelligent Health really centers on the individual. Talk about what prompted that sort of pivot to the individual versus the macro systems. Talk about that in the book Intelligent Health.
- [04:28]
B
Yeah, absolutely. So, you know, it's interesting, Scott, as I reflect about the last two decades of my career, I have realized that this focus on the person was always something that was near and dear to my heart and part of my core mission. So back again, going, you know, two decades back when I was put in charge of our health system readmission program, I actually created a program that was called Person Centered Readmissions. And the reason that I did that was that we had done extensive chart reviews and found that despite, despite significant data from the literature on what causes readmissions, like lack of follow up with a primary care doctor or medication reconciliation issues, that those weren't really the factors that were leading to readmissions with our patient population. And I remember I kind of got this data from our Analyst at about 6pm One night I was sitting in my office at UCLA and I was like, well, what does cause readmissions? And printed out the list of patients who had been readmitted overnight and walked onto the floor at UCLA and just started talking to patients, introduce myself, ask them why they came into the hospital and this may shock you, Scott, but I found that again, for our patient population, it wasn't that they didn't have a primary care doctor or a specialist. It wasn't that their medications interacted negatively and that's what led them to come in. It was that they felt safer in the hospital. So if we wanted to prevent readmissions, we had to address their sense of safety when they were transitioning. Home. And so we rebuilt, and that's why it was called Person Centered Readmissions. We rebuilt the whole program to do an assessment before discharge around how comfortable and safe do you feel at home? And when people didn't feel comfortable and safe, what were those factors and how could we help address that? And that was a thread that went with me. I set up some of our first patient family advisory councils. And I realized as I went through my career, especially as I became a chief operating officer and then when I worked globally through Oracle, that you have to really understand what does the person or consumer of health and care need. And those needs really vary from person to person, even if they are within the same zip code or geography. And you have to ultimately be able to be able to address that. And then that brings us to intelligent
- [07:07]
A
health and talk about that, because obviously at the end of the day, there's these macro concepts, there's population health, you worked a lot in population health. But then there's actually the very real individual. Is that individual moving enough? Are they going to the doctor when they need to go to the doctor? Are they drinking the water they need to drink? Are they eating healthy or are they eating not healthy? Are they taking their medicine that they're not? How do you get from this macro level to really working the individual on the individual level? It's an inspiring goal. What does that look like in practice? And how can we tangibly improve a person's health by really looking at it from this micro level? The individual person versus the macro system level?
- [07:51]
B
Yeah, that's a really great question, Scott. And the really exciting thing about sitting here in 2026 versus, you know, again, looking a decade ago or two decades ago, is that technology is now enabler to help us have that personalized precision health and care path for the, for the individual. So the idea behind Intelligent health falls on three kind of core premises. The first one is we have to unify data. We have to unify the 20% that determines someone's health, which is what happens within healthcare delivery Systems, with the 80% that determines their health, which, as you know, Scott, the air we breathe, the food we eat, the stress we carry, our genetics, our habits. It is unbelievable to me that we make such critical decisions about health and care with only 20% of the information. You wouldn't get on a plane if the pilot came on and said, thank you for flying with us today. Just want to let you know I only have 20% of the data to get you to the destination safely. But I'm Highly trained and very well intentioned. I mean, you would get off the plane. Yet when it comes to our healthcare, we are focused on the 20%, leaving the core elements that determine our health to the side. Well, now we have the technologies to be able to unify that 20 with the ad and for the first time kind of see the whole person. The second pillar of intelligent health is we now can apply intelligence so that with all of these streams of data that we have, from our wearables to apps to genetic testing that we DO, full body MRIs, testing of lots of blood panels, along with our electronic health record, we can actually distinguish signal from noise. So we can understand and have insight into what drives health and care today and foresight about what's going to drive our health and care in the future that enables us to have the ability to make different decisions today. I have a fun story about that that I'll, I'm happy to share with you later. And then the last pillar of intelligent health is this capability. This unified data with a layer of intelligence has to be person owned and person driven because when you own your data, when you have control over it, you are going to fundamentally think and act differently and you're going to have human goals. We've kind of trained people, like if I ask you what are your health goals, you may say you I need to control my cholesterol more, I need to lose a couple of pounds. These are clinical goals. We've trained people to think about health in a clinical way. The thing is that we need to think about health in human ways. I want to wake up in the morning and have energy throughout the day. I want to go from meeting to meeting with a clear head. I want to be able to run with my kids and not have musculoskeletal pain. These are human goals. The intelligence on the background can take the 20% of your chronic illnesses with the 80% of your lived context and tell you on a day by day, minute by minute basis, how can you make better decisions to get to those goals.
- [11:23]
A
So thank you. And I think that's right on. I mean, in so many different pieces of life that we have, the whole game is to be able to show up present and alert and feeling good and to be able to move how you want to move and to be, you know, ready to go and raring to go to sleep well, to feel good. All these things. Talk for a second about artificial intelligence. You know, there's one school of thought, you see it on Twitter often or X that AI is Going to take over everything. We're not going to need doctors. Most of us, I don't think, view it that way. We're very concerned that we have enough specialists, enough doctors, enough to take care of us. Where does AI fit into all this and, and how will it be useful and what are the limitations?
- [12:08]
B
Yeah, I think that there's kind of two major areas where AI is going to be absolutely instrumental. I think the first one is to take away the tasks from the person that should have never been done by a human being. There are, as you know, tremendous administrative tasks that highly trained physicians, nurses and even staff do that. Honestly, we no longer, with today's technology, we no longer need a human to do those tasks. We should take that away so that we are freeing up time and cognitive bandwidth for people to actually do the human work, which is connecting, communicating, building trust, actually being able to do complex decision making that relates to the lived context of the person in front of them. I think the second way that AI can be absolutely helpful is where it can help augment the work that's already being done. We know, Scott, that we have long surpassed the cognitive ability of clinicians to integrate all the data that's out there that's continuing to grow and develop. We've surpassed the ability to cognitively bring all of this stuff together and be able to integrate it in the right statistical way for the person in front of us in clinic or in the hospital. AI gives us the ability to do that. It gives us the ability to pull all of that together, the latest and greatest data. It gives us the ability to pull real world evidence which we would not otherwise have access to. It enables us to augment the human. It's similar too, with clinical documentation now, being able to take some of that away from nurses and physicians and having systems actually do that again, augmenting the human so that you're, you're building more bandwidth. So I think, you know, those are two critical areas where it can be very helpful. I do not believe that AI is going to replace healthcare providers. I absolutely believe that it is going to require them to think and function differently. And that's a good thing. I didn't get into medicine to practice the way people did 20 years ago or 50 years ago. People today should not be wanting to practice medicine the way we did 10 years ago or 20 years ago. We need to grow and evolve with these new tools. But to your point about, you know, what are the, what are the downsides again? I think that there are two that are very top of mind for me, one is around these generative AI models are ultimately trained on existing data and are only as good as the existing data that we have. And we know that there are major gaps that we have with training data. We have gaps in the training data when it comes to things like women's health or with mental health. And these are areas where these LLMs can really fall short again, not because they're malicious, but because they haven't been trained appropriately for the task ahead. So we have to be very cognizant of Is the question that I'm asking, is the augmentation that I'm requiring appropriate for the model that I'm using? And then I think the second piece that I really think about and worry about is around, as we use these systems more and more, as we are deferring to them, are we continuing to build and develop our critical thinking skills, our abilities to discern what is right and wrong? And I do think that that's a very human skill that's critical to continue to build. And there was a study out of MIT where they asked a group of adults to write an essay. And they asked for the. For the group that was just told to write an essay. They then did EEGs and kind of followed their brain patterns. Their brain was firing. For another group, they write an essay, but you can use Google as a search engine. The brain for those folks were firing, but less. And then they asked a group to write an essay, but leverage a large language model, and the brain there was minimally firing. Then they asked people to recall something from their essay. And again, if you wrote it yourself, you recalled it. If you use ChatGPT, recall was really poor. They asked people how satisfied they were with their work, their level of happiness, if you wrote the essay, if you toiled over it, you were actually, you had more fulfillment and happiness over your work all the way to. If you leveraged an LLM, your level of joy, happiness, fulfillment went down. So I bring that up because I worry about, at a time when we have burnout and workforce shortages, that how we use these have an impact in how we feel and how we perceive our professional work. And we have to be mindful that it's not further eroding at the workforce that is already, you know, quite taxed.
- [17:26]
A
Thank you. And the point you make, and there's so many points there, one is that I hear this from teachers today that as students rely so heavily on AI and ChatGPT, well, their work product may be good. Their ability to actually rigorously Think is not being improved nearly as much. And that is a real, real challenge. The other thing you said that I think is so right on. I see that a different context in the oncology world. It's just the level of cognitive overload that oncologists are facing at a time when there are shortages and more people with cancer and so forth. And trying to deal with that cognitive overload and filter through so much information to be effective as a physician. And even though the tools are so helpful, there still is this incredible challenge of being able to avoid burnout, maintain empathy, think clearly and filter through thoughts in a time of tremendous cognitive overload.
- [18:25]
B
Absolutely, absolutely. Scott, I just had a. It's interesting that you bring up that case. I had a good friend of mine reach out the other day and she is now 6 years cancer free from breast cancer, was seen at one of the top three cancer institutes in the US and was just a regular annual visit. She had to wait over 90 minutes in clinic to be seen. And there were a number of issues that she needed to go through. She had all of three minutes with her oncologist and again, there was a lack of empathy and understanding for the fact that she had moved her entire day around to actually be present. And I think a lot of people encounter this. And again, we have surpass the cognitive ability for people to pull stuff together. It's causing exhaustion and burnout, which really gets at compassion and empathy for the person in front of us. And there are solutions through leveraging technology not as a panacea, but as a powerful tool to help us move forward.
- [19:31]
A
But I think your point is well taken that it's not a panacea. We need both. We need technology and we need doctors. No time to think, to treat, to think, to actually to avoid some of the cognitive over. What you're talking about is that concept. If you get three minutes with the physician, it's a very important diagnosis. And that physician spends three minutes with you because they're trying to sort through all this different, different places that's supposed to simplify it, but humanly it's just not possible to work through that in the right way without having a little bit more time and a chance to decompress and to think clearly. When you think about intelligent health and what you write about in person, centric care, what does this look like over the next five to 10 years? What shifts you see? How do you see this? If it's working out well, and then take one more moment at the end of this doctor at the start to tell people where they can find the book Intelligent Health.
- [20:21]
B
Yeah, absolutely. So, you know, if we are doing this right, Scott, what five to ten years from now will look like is individuals empowered and engaged in their health, not in their illness. And again, there will be illness, but this will be part of our health and how we are moving and advancing. We have the tools, we have the empowerment to actually be able to thrive. But what's really critical about this, and I spend an entire section in the book kind of going chapter by chapter through the evolution that healthcare delivery systems need to take the payers and employers in health care, the pharmaceutical companies, med tech, retail pharmacies, food and beverage companies, regulators and policymakers. I talk about how each of these organizations, instead of functioning in silos and at times competing with each other or creating friction, how they will evolve around the consumer and ensuring the consumer's health. I specifically address how do they each preserve their individual mission and their margins, but around health as opposed to supporting illness or contributing to illness in some cases. So if we're doing this right, the entire ecosystem of health and care, because we have a large complex ecosystem, we can't blow up any of these stakeholders. We are too interconnected. But how can we evolve all of them? Leverage, leveraging this technology to be around the only constant that they all share, which is the individual, the consumer of health and care. And how can they focus on the. On the health of the individual? All of this is explained in depth in my book, Intelligent Health. The movement to unify data, harness AI and empower people to thrive. You can pick up a copy anywhere you get your books and ebooks and would love to hear any thoughts and dialogue that you have. You can follow me on LinkedIn. But this was a lovely conversation, Scott. So happy that we got a chance to catch up.
- [22:39]
A
Dr. Epstar, just a pleasure to visit with you. Thank you so much for joining us today on the Beckers Healthcare podcast. It's a remarkable career. It's remarkable to visit with you. I look forward to digging into Intelligent Health. Thank you so much for joining us.
- [22:51]
B
Thank you, Scott.