Addressing Disparities in Transgender Care

Webinar

Featuring

Standford Medicine

Description

Transgender individuals and sexual minorities face major healthcare barriers that don't often get discussed. According to the National Institutes of Health (NIH) the biggest barriers come from lack of access to knowledgeable providers.


Dr. Kavita Mishra, who specializes in transgender medicine, joins us to discuss how these disparities impact sex & gender minorities (SGM). Join us in a conversation about both the impact of these issues and thoughts on how healthcare leaders may start helping to create a level field.

Kavita Mishra

Dr. Kavita Mishra

Clinical Assistant Professor
Stanford University School of Medicine

Standford Medicine

Chris Hemphill

VP, Applied AI & Growth
Actium Health

1

Transcript


Chris Hemphill:
All right. Everybody, hey. We're excited to talk to you today. Hello Healthcare watching us on LinkedIn live, hello. Or if you're watching us a little bit later on YouTube, hello as well. However you're able to consume this, we're just happy that you're interested in this subject because it's a far-reaching subject, it doesn't get the attention that it deserves, but it impacts up to 25% of our population. So it's something that we need to be focused on is these disparities in veteran care.

Chris Hemphill:
So joining me from the Symphony RM side, our VP of clinical platforms, Terry Tuznik, who actually is a Navy veteran and served as a nurse in the military. Quick hey from Terry.

Terry Tuznik:
Hello. Good morning.

Chris Hemphill:
And Evelyn reached out to us after we did a presentation discussion on Walmart Health. It was a part of the conversation that I hadn't included in that discussion, but she called in and we discussed at length the situation for veteran care with within healthcare.

Chris Hemphill:
Evelyn served in the Navy as a doctor and also leads the... Most recently, what kind of sparked this conversation is her leadership with the Veterans Health and Wellness Foundation, which provides resources and education and communication resources to aid with veteran care. So I am honored, Evelyn, to have this conversation with you. And just wanted to give you the opportunity for a quick intro too, as we go into the conversation at hand.

Evelyn Lewis, MD:
Well, thank you, Chris and Terry, for having me. I think you did a great job with the brief introduction there in regard to... I'm a veteran myself, Terry and I, both, have come to know that we both served in the Navy. I was there for about 25 years and retired several years ago. And I think it was that and at the height of the Iraq-Afghanistan conflict where my interest and commitment to understand the need for others to really know the [inaudible 00:02:22] into the spotlight, if you will. For me, at least. And so I'd been working with veterans and their families in relationship to their health.

Chris Hemphill:
Well, thank you for sharing that story. And as we go through this conversation, we'll hear more pieces of that. And we'll hear how that's evolved into what the foundation has made available. And we're going to share thoughts in terms of... I know that a lot of our audience is on the patient engagement side, or on the administrative side, or on the IT and operations side.

Chris Hemphill:
So we're going to be thinking through what organizations can do whether you're in a hospital or other types of organizations, but we'll be thinking through ideas on what you might be able to do to better serve and address these communities and groups with veterans. But typically how we do this for anybody who's new to this type of conversation is it's a live conversation.

Chris Hemphill:
The reason that we have Terry and Dr. Evelyn here is so that you can share your perspectives with them and understand and get feedback from them about your thoughts. So, any questions you have, any stories that you have, anything that you relate to that they're saying, feel free. This isn't like a seminar where you have to hold silent until the end. This is just a conversation with us all. So feel free to share your thoughts and we'll address those and take those head on.

Chris Hemphill:
So appreciate you being here. And we'll just go ahead and get started. Evelyn, with your background and everything that you went through in the military, I'm just curious on what got you interested in, like you referenced it, at the height of the Afghan conflict, what got you interested in starting this foundation to start addressing veteran healthcare disparities?

Evelyn Lewis, MD:
Well, [inaudible 00:04:23] when I spoke to it about the Libya conflict there was evidence that those who were being cared for, even our iconic institutions like Walter Reed, that used to be the national level medical center and others were at a point where they were feeling they weren't getting the care that they needed and needs weren't being met. Even though they were in military facilities getting this group. And so out of that came the understanding that they needed providers or healthcare professionals who better understood who they were, what their unique healthcare needs were, et cetera.

Evelyn Lewis, MD:
And as we all know, the primary or the signature injuries of the Iraq-Afghanistan conflict identified by the Rand Corporation was traumatic brain injury. And so that with PTSD and was other physical injuries, it became very clear as to why [inaudible 00:05:26] they were feeling. And so out of that came to me the need to educate healthcare professionals who were providing that care about who these people were and what their needs were.

Evelyn Lewis, MD:
So that's where it started, but as you move through that I'm sort of a top down bottom up person so that we understand that those pieces, if they don't connect with everybody, [inaudible 00:05:50], it isn't really getting the message. So while we were educating the healthcare professionals on this end, we needed to also educate veterans and their families on this end, so that they understood that a lot of what they might be experiencing may be directly caused by their service or associated with their service or associated with the care that they were or weren't getting, because we all know that access to care doesn't guarantee you get what you need.

Evelyn Lewis, MD:
So it was that sort of interest that said to me, a foundation [inaudible 00:06:24] part of this so that those pieces get addressed. And I think that a lot of that had to do with who I am and how I'd be to patients. You mentioned that I was a physician in Navy. My specialty is family medicine, so I don't just look at an individual or a disease, I look at the individual, whatever the issue is, injury illness, or disease, and then the context that they represent within a family. So it was from that perspective that I began to think about the need for a foundation to address these issues.

Chris Hemphill:
And Terry, just a little bit earlier, you were sharing some stories as far as gaps in knowledge and different things that Evelyn's focusing on addressing. How does that story that she shared resonate with you?

Terry Tuznik:
So when I was a Navy nurse, which was... I was active duty back in the '80s and I cared for a lot of Vietnam era veterans. I noticed differences in how they approach things because of the experience that they had being in Vietnam. And even as a Navy nurse, we were never taught really how to relate to patients who had gone through those experiences. We did have this shared bond of all having been in the service and being active duty, but we were never taught how to care for those patients and really holistically look at them. And as a veteran, one of the things that I do is sort of an informal advocate for veterans dealing with the VA, totally different topic. But I see where they need some care, especially our now Iraq era veterans, where they're going through different things than the patients that I even cared for in the '80s while I was active duty.

Terry Tuznik:
So to me this is near and dear to my heart because I'm seeing such a knowledge gap and how to care for these patients. And one thing, Evelyn, as we were talking a little bit earlier, I think we have an audience out here who are not with the VA who may not understand the impact and the amount of patients that this actually touches, not just the patients, but their families. I would love for you to talk a little bit about what we were talking about earlier which is who are these people? And they are part of your community and not necessarily part of the VA and going to the VA. Would you mind explaining that again? Because I think that the audience needs to understand these are their patients. They're a large part of their patients.

Evelyn Lewis, MD:
Sure. As we all know, again, depending on whose numbers you look at, there's about 18 to 20 million veterans [inaudible 00:09:28]. Those continue to decline a little bit, but nonetheless, right now looking at about 18 to 20 million and of that number, only nine million are actually registered with the VA. And I'll stop right there because that's very, very important. The vast majority of healthcare providers in... Unlike healthcare professionals and leaders in the healthcare sector, think that all veterans get their care from the VA. And that is sort of the number one stumbling block, because again, as I mentioned, there was about 20 million altogether, but only nine million are registered.

Evelyn Lewis, MD:
And you must be registered to get care from it, okay? So of the 9 million who are actually registered at the VA, only 6 million, actually go there to get some care, okay? And when I say some, that's because of that 6 million [inaudible 00:10:27] of females get all of their care there and about 12% of males get all of their care there. The others get some there and some on disability side. And so that's important to know.

Evelyn Lewis, MD:
And one of I think the main questions that I've asked of civilian healthcare facilities and leaders of others is that when they tell me they don't see veterans, is I asked them, how do they know? Okay. And that's a big question because they're not asking when they're screening folks. It should be a part of the intake or at least at a bare minimum the social district, on where you're asking that question, are you a veteran or have you served in the military? And if they say, no, the next follow on is, has a member of your family done so? Because the family's impacted just as much as the veteran and some of these vets we got in the service.

Evelyn Lewis, MD:
And so I think it's very important to understand that really either [inaudible 00:11:28], they get all their care or a portion of their care in the civilian sector. And so it's critical that you ask that question and then once you ask it, is that you do something when the answer is positive. There's data out there that indicates that there are hospitals that asked that question, but then they don't do anything with the information. So again, that's not helpful either. And so those are the critical criteria to getting this on the right track and ensuring that veterans get the care that they need. Well, one other point I'll make around that same question that you asked is that sometimes when I've asked that question, they say, "Oh, well, we know because we can see where they have tried care. A lot of veterans when they come out to have tried care, or there'll be some indication that someone was seen at a VA facility.

Evelyn Lewis, MD:
And so the civilian hospital or clinic will say, that's how we know our veteran population. And I said, "well, that [inaudible 00:12:30]." But as a veteran myself, when I retire, I went to work at industry. I used insurance through the company, so there was nothing that identified me as a veteran. And I will tell you, since 2003, when I retired, I'd never been asked that question, me going in for care. So again, it's the ability to understand one that we're not all seen there. And then secondly, when you ask the question and you get the yes answer, what to do then, how to follow through on that, so that you can then provide the care that that person needs.

Chris Hemphill:
So thank you for that. And one thing that you said earlier with regards to access, not necessarily guaranteeing outcomes or necessarily guaranteeing people are going to use those services that really resonated. And with a look from when you first started all the way until now, has there been any overall change or how would you describe the state of care and availability and utilization for veterans. How do you describe the state today versus back then?

Evelyn Lewis, MD:
Well, it's a little difficult to give a direct response to that because as the saying goes, when you've seen one VA, you've seen one VA and it applies to our civilian organizations also. We know that there are some when you go to the VA who give you excellent care, high quality. They're very attentive to your needs. They follow up and the veterans who go there feel like they would never go any place else. And there's no reason to even think about it. Then there are those veterans, like the young lady I got a call from last week. She found a number through the foundation site and called me, lives in Georgia [inaudible 00:14:29].

Evelyn Lewis, MD:
She spoke to me for an hour without even breathing about the non care she was receiving from the VA. She's 100% service connected disability. So she says, "I'm one of those veterans. I get all of my care at the VA, and they're just not listening to me. I'm not getting this, I'm not getting... " As I mentioned, she went on for an hour without taking a breath about the lack of care that she was receiving. And so, again, that's one facility, one patient. And so when you look at that as an overview of what's out there, you get that blended response of some is excellent, and some is far from that. There is no standard of quality in the VA facilities, [inaudible 00:15:26] if you've seen one, you've seen them all.

Evelyn Lewis, MD:
So again, there needs to be some additional focus around quality of care across those facilities, just as we need to do the same with civilian facilities actually. It's no different. We have all these large healthcare systems in the civilian sector where they have hospitals all across the nation. And so they need to have some standard of quality by which they measure the care they deliver also. And I think that that would be helpful to a certain degree in at least ensuring that a certain level of care is always attained. It may not always be an A plus but it's not a D either.

Evelyn Lewis, MD:
And the other piece that I mentioned around that that I feel is very, very important for all of us to understand is that Abraham Lincoln back in his day and time, made a promise to those folks who would put a uniform on and go and fight for their country. I always paraphrase what he says because his inference was only for males who serve. But his promise says that we would care for those who have borne the battle. And we're very... We're doing a very poor job of that in a lot of different places. So again, when you ask, has it improved? Some places it has, some places it hasn't. There is really no across the board measure that all of them meeting in regard to veteran healthcare.

Chris Hemphill:
Understood. And when you mentioned the woman who called last week and talked about her experiences, and she was able to talk to you for a solid hour and really get feedback and have an ear that she hadn't had before, it makes me wonder about... that's a major accomplishment in itself. And just looking at the foundation as a whole, I'm curious about things that you'd like to highlight, anything that you highlight, stories that you can share as far as what the foundation has accomplished? I think that's going to help inspire people to think about how they can approach within their own markets and populations as well.

Evelyn Lewis, MD:
Well, thank you for that question too, because I think this really gets at the core of what we do, why we do it and how we do it. One of the things that I've come to know in being in this business of attentiveness to veteran healthcare is that there's a lot of information out there. We can debate whether the VA gives the healthcare that they need, or the level of quality that you can deliver. But one thing is for sure, and that is [inaudible 00:18:28] enormous amount, very, very good relation of it. The problem is, most people don't know it's there, and most people don't know how to find it. And so there's nothing worse than being better than sliced bread and having someone who doesn't eat carbohydrates, okay?

Evelyn Lewis, MD:
So the focus of the foundation is the health of veterans and their families in regard to information, understanding, and how to apply that, or how to navigate hospital systems, how to navigate the VA, how to understand their service connected disabilities and ratings and all of those kinds of things. And so a part of what we do is curate information that's out there around those different topics. So we try to bring it to our website, so when someone's going through there, "Oh yeah, well, this is something I need right here." Or they can ask the question and hopefully if the answer isn't on the site right then [inaudible 00:19:32], pointed in a better direction.

Evelyn Lewis, MD:
So they're not combing through volumes of information to get an answer to their question. Understanding who and where they go to for certain responses that they'll need. Oftentimes, as I mentioned, a young lady who called, we sort of give that one-on-one attention to, and sometimes the vast majority of what's needed is somebody who is listening for what they're saying, that they feel like they're be heard. When she finished, I said, "Well, you know what we're dealing with here is a problem with the system." And as much as we understand that that's an issue, we won't solve that today. Okay, so I said to her, "This is something we can do now that could potentially help you with what you feel. And so then I began to outline a few steps that she could take one of which she didn't know [inaudible 00:20:32] eligible for TRICARE.

Evelyn Lewis, MD:
So I said, "You could apply for TRICARE as an individual, it's not a very expensive or heavy financial burden" And then you would get some additional coverage where you could go in the civilian sector and perhaps find someone there who you've trusted more, at least you could go to them to ask questions about what your care was being directed or the direction your care was headed in through the VA. And that way you could get some reassurance and feel more trusting of the folks who were providing that care. So you would have thought that I had resolved all of the years of problems that she had with the VA when it was something very simple, again, not knowing exactly all of the benefits she was entitled to that were extremely helpful to her there. But there are a number of pathways as I was mentioning that provide this care for veterans about educating healthcare professionals.

Evelyn Lewis, MD:
So I get colleagues of mine. I applied for grants to pay different physicians and other providers to do webinars on specific topics, everyday topics, systemic lupus, pulmonary arterial, hypertension, cardiovascular disease, diabetes. All of those are diseases that impact anybody, whether you're a veteran or not, but they do have some extra added issues. If you are a veteran, i.e. your risk is significantly higher if you're a Vietnam vet and exposed to agent orange. And so, again, as a clinician, knowing those things helps you immediately be able to understand that you should do something sooner in terms of screening or what have you for this patient, who's a veteran than you would for someone else. So that's one mechanism, the other, you heard me talk about educating veterans, themselves, their family members and their community.

Evelyn Lewis, MD:
We also have a [inaudible 00:22:35] grants and through the Georgia Healthy Family Alliance was awarded a $6,000 grant that helped me then position the foundation on this platform that serves as a resource to help veterans meet their other needs. The foundation focus is health, but we all know by terminology like social determinants of health, that regardless of how willing that individual is to do what it is you've directed them to do or mutually agreed that they need to do, can't be done if they're losing their home or they just lost their job or they have food insecurity. So this platform they can go in, it's free to them. Again, thanks to the Georgia Healthy Family Alliance, they go in, they put their zip code in, and if they're in need of food, [inaudible 00:23:33], that comes up different categories, food, housing, finance, et cetera. They click on food and all of the organizations within their zip code that can help them with that on this thing. And they can be directed there immediately.

Evelyn Lewis, MD:
There is a way of direct referral, but right now we don't have the capacity to do that. There are organizations who can use a similar platform when veterans call in. They can take that issue that they have, go through the organizations and then directly connect them to one or two that can deliver on answering their questions. But right now we don't have the capacity to do that, but they can use that tool and understand that all of the organizations in there are credible and reliable and will deliver on the needs that they have. So those are ways in which we help veterans [inaudible 00:24:33], give care and other civic needs that they have.

Terry Tuznik:
Evelyn, I wanted to circle back around on two things. One, hank you so much for some of the things that you do as far as education for providers of care about the differences with veterans. I was doing some research after we set up this call with you and just really not finding a lot of education for any type of clinicians, nursing, medical students. And so I appreciate you mentioned earlier that you've done some education and getting first year and third year medical students, but because there's not a lot of knowledge about veterans and their health, are there any major misconceptions about veteran health status that healthcare providers, institutions should be aware of in your opinion?

Evelyn Lewis, MD:
I'm sorry. Could you repeat the last part of your question? You were breaking up a little bit.

Terry Tuznik:
I'm so sorry. Are there major misconceptions about veteran health status that healthcare provider organizations should be aware of?

Evelyn Lewis, MD:
Well, I think so. There are a number of ways to look at that. I've referred to some of that a little earlier, when I was talking about the numbers of veterans who are actually seen in the civilian sector. But again, understanding that this group of people, this population of people we're talking about, they're very loyal to those who know them, who understand them, who exhibit a respect for who they are and what they've done. And regardless of conflicts that a country engages in and why they do what they do, the men and women, families who serve, who volunteer to serve these days, because we don't have a draft, but volunteer to serve. They need us to understand that when we are responsible for providing some of that care. And so if you become one of these organizations who has an interest, who really wants to better understand who veterans and their families are, getting the type of education or enhanced awareness that we've talked about earlier is key.

Evelyn Lewis, MD:
But also there are other visuals, other indicators that you as an organization, understand who veterans are. So while you might not think anything of it, having all the service seals or the flags that represent each of the services displayed in your lobby, when a veteran walks in and sees that it speaks volumes to them compared to just walking into a space that doesn't have that. Those folks who we call service support personnel, who sit at the front desk or your information desk, when they are greeting people, et cetera they could ask, "Are you a veteran, or have you served in the military?"

Evelyn Lewis, MD:
And if that person says, yes, they can respond, "Thank you for your service." We ask that question because we want to make sure we provide you with the care that you need, because oftentimes again, if providers don't know that then those certain questions are asked where there's no follow on questions to gather additional information. And so those are the kinds of things that would be extremely helpful to the organization themselves. Because once veterans feel they found a place where they get the care [inaudible 00:28:35], care about who they are, they begin the marketing and communication piece for you because they're going to tell their buddies and then their buddies are going to come also.

Terry Tuznik:
Yes, I agree.

Chris Hemphill:
So that's a powerful perspective is by putting a foot forward and showing the compassion and empathy for people who have gone through those services, it makes a much bigger difference than just walking into your generic hospital lobby. Another question that's kind of related to that is just... One aspect of that you were talking about was when people are... when people are first engaging with somebody who may be a veteran or may have served asking the question. So I'm curious about anything else, like we had a little bit of a conversation beforehand, just about the lack of overall data available. And I'm curious if you see ways that maybe providers or health systems could be doing a better job collecting the data that they need so that they can better respond and make resources available and make communication available for their veteran populations.

Evelyn Lewis, MD:
Yeah. I think that's another critical question in regard to data. And when I'm talking about that of late, I use the example of the recent healthcare crisis. We all just came out of the other end of, and that's COVID-19. And so if you were to think about it, all of the data that we had, that talks about the impact of COVID-19 on the veteran population comes from the VA, okay? We had a higher percentage of veterans who got ill, who got significantly, or seriously ill from COVID. And those who died form COVID, those numbers were higher for that population and for the general population.

Evelyn Lewis, MD:
You all heard me say earlier that only six million of the 20 get care at the VA and of that six million, a huge portion of them get additional care outside of the VA. So we have no real handle on how many veterans in the civilian sector actually got COVID, got seriously ill from COVID or died from COVID. And because we know that there's increased risk in the veteran population from a number of these things that we've talked about, hypertension, diabetes, obesity, all of those things that we said put people at high risk to get COVID in the first place. So when we think about that, the question I have is how many veterans did we lose who we have no idea about, okay? Including those, again, with PTSD, TBI, all of those things, [inaudible 00:31:36] who were getting help for their issue with PTSD and TBI do so in peer groups, they get counseling, they get support from their peers, and have the same kinds of things, and they do these in-person sessions.

Evelyn Lewis, MD:
Well, COVID eliminated all of them, all they could do is see people like we're talking now, which was a good way to continue. But it's very impersonal as we know, the connection is not quite there the same as when you're face-to-face. And so, again, I have the question of how many veterans did we lose to COVID-19. And so if we had hospitals and clinics who were gathering that information, that would be extremely helpful. Again, if you were a facility, when a veteran came in during the COVID [inaudible 00:32:35]. Came in, they identified, you asked that question, they identified themselves as a veteran. And then you said, "Well, what era did you fight in." Because that gives you huge clues as to what their increased risk for disease, injury or illness might be.

Evelyn Lewis, MD:
Agent orange in Vietnam, burn pits, and what have you... And in the gulf one, burn pits in gulf two, but they were burning different things, so the particulate matter differs. And so did the injuries to the respiratory system will also differ. So you had those kinds of issues at hand that have to be considered, and that's why having that knowledge, collecting that information and using it, not just collecting it, but using it to inform how you then interact with those who are coming to your facility for care.

Chris Hemphill:
So that's huge too, especially it really drives into how studies are reported and how data systems are reported as well. Because if somebody looks at the statistics and big figures, they might think that that's representative of the entire veteran population, but there's a gigantic amount that we don't even know based on the figures available. So it kind of raises the question, raises the issue to the point where hopefully people might hear a conversation like this, or might do some additional research and find out the lack of information available and start operationalizing that to where they're collecting that early on. We are past our typical 30 minute mark, but that's pretty frequent. We just have a couple of questions left.

Chris Hemphill:
And this one gets into the core of the conversation of, "Hey, what are some... " If we're looking for strategies or different things that we can do as organizations or healthcare leaders, I'm curious Evelyn, what health systems you might've seen that are effectively managing this? Or what kinds of strategies have you seen? If there's any stories, if you want to name any institutions, totally fine. If not, that's fine as well, but just curious about who other people might be able to look to as leaders in, in addressing veterans' care disparities.

Evelyn Lewis, MD:
Well, there are some facilities that have begun to integrate some education of the providers that are part of their organization. That is a very good start, but as we all know education alone doesn't necessarily [inaudible 00:35:38]. And so as a physician myself, and I'm sure Terry is a nurse, we've done CME all our lives and continue to do that. A lot of it excites us. And when we go to a conference and again, gaining information, we go back and we're all ready to implement some of the things that we learned about. And then the reality of the 10,000 emails, we did match it when we were away or sitting there and waiting for us. And then all the other things that we normally do when we're sitting where we are or working where are, are there.

Evelyn Lewis, MD:
And so we start to get back into that routine. And then what we intended to do when we got back begins to drift further and further away. And so there needs to be reminders and there needs to be an effective way of assessing whether or not once a clinician engages in this [inaudible 00:36:38] in the case of the training and education, are they applying it? Okay. One, if they found it helpful, if it enhanced their knowledge, what are they doing with it? Because if they don't do anything with it, if they don't integrate it into their interaction with the patients, then nothing changes. And so the real question is if we provide the education, enhance the provider and the allied healthcare professionals, knowledge about these unique issues around veterans and their families and their health, does that make a difference?

Evelyn Lewis, MD:
So as they learn these things and implement these strategies in their practice, isn't enhancing the outcomes of the veterans. And an example, as I mentioned, COVID-19, if facilities were asking that question when they came in. And you had someone who was a veteran, they responded yesterday, you knew they were a Vietnam era veteran. So immediately, there's a very good diagram from the VA that says these are lists of things that they have agreed to now for some time that were associated with or caused by that exposure to agent orange, okay? Diabetes, certain cancers, and all these sorts of things. So if you had a veteran come in who was exposed to agent orange, who is obese, who has a diagnosis of hypertension, diabetes, or whatever else. You might say immediately, let's not do this and see whether he gets better, let's immediately take him here, and do X. If you had a veteran from the Iraq Afghanistan era, and you knew they were exposed to particulate matter from burn pits, the VA hasn't come to any conclusion [inaudible 00:38:40] injuries and diseases they're going to associate with that, that's being actually currently looked at right now, but none of that has been defined.

Evelyn Lewis, MD:
But we know from some of the studies that have been done, that there are indications that, that causes significant respiratory compromise in some individuals. And so let's not wait for this guy to get bad. Let's immediately put him over here and do X because he is at higher risk, not just because of the diabetes and hypertension or because of the respiratory insult he's had due to exposures. So those are the kinds of things that I think we miss. We do the first part. We do the CME, et cetera, but we've got to understand, we've got to track that. Are we using what we have learned? And if we're using what we're learned, is it making a difference? If not, what kinds of adjustments do we need to make?

Evelyn Lewis, MD:
And I submit that this [inaudible 00:39:38] or collection of data needs to be going on at the same time that we are doing things, that we are actively implementing whatever it is we're looking at and learning, because veterans have waited long, long stretches of time to begin to even get the care that they need. They don't need an additional long runway of time for more data to be collected before they began to get more specific care. Okay? So that's what I think about when we ask that question, what needs to be done, what can be done? We're a smart enough a country that we can do more than one thing at one time, i.e. chewed gum and walk. So I think we should utilize our abilities to do those kinds of things when we're looking at patients who are at higher risk of of losing their lives.

Evelyn Lewis, MD:
And not that anyone else does [inaudible 00:40:39] as specifically and especially for those who have defended our freedoms. So I think those are the kinds of things that civilian healthcare organizations in particular should be thinking about as we move forward and as they begin to learn more and more about this. Is yes, asking that question, understanding what needs to come that's if the response is yes, or even if the response is no and then understanding of what they do with that information, once they have it, i.e. act on it, don't just collect it.

Chris Hemphill:
Love the phrasing of that. Actually while you were talking, I noticed from our department, our manager of analytics was appreciating the post too. And I think that a perspective that we often think about on the data science side is that if there are pieces of information that might relate to risk or different healthcare outcomes, if we don't have that in the machine, then we can't make a prediction based on it. We can't change actions based on that. And it kind of translates to if somebody is operating without knowledge of... Like you were referencing, if I have the knowledge on has this person served, and what era did they serve in? And there's a cascade of different behavior, different questions, different actions that I would act on, but that's completely blocked out by this process.

Chris Hemphill:
I wanted to flip a similar question to Terry because a big theme of this conversation and a big theme of webinars we've done in the past. We've had these patient experience panels where people have talked about their experiences and a common theme around that is that if you don't know how to navigate through the healthcare system, then you're at a significant disadvantage. So I'm curious, Terry, if you've had experiences or seen examples of health systems that are managing care well, or making good resources available for veterans, and if not, then that's totally an acceptable answer.

Terry Tuznik:
So it's interesting, as Evelyn you were talking, I was sitting there in my brain saying, "Wow, if we could get that data and use that for our engagement, right?" For our nurtures and nudges to our veteran populations from a data science... If we understood that they were veterans and what era. We could make guesses of the era, but it really is such critical information. And Chris, to answer your question from a veteran perspective, I have not any type of additional engagement that would make that veterans journey easier. Evelyn, when you were talking about having conversations with veterans about their options for care, again, it's something I've done informally. So, so happy to see your organization because I really feel like it's such a needed... People don't understand what their benefits are, what their rights are, what the journey looks like for them, and the fact that you're helping them do that is just amazing. So thank you so much.

Terry Tuznik:
I wanted to end with you. Do you have any final thoughts that you'd like to leave the audience with as they reflect upon this webinar? We've had such great information that you've shared, but what would you like to close with?

Evelyn Lewis, MD:
Well, what I'd like to close with is I don't want you to just have heard what we talked about. I want you to take what we've talked about and look at how you can do something with that information that then benefits those veterans and the families you have served. Because again [inaudible 00:44:40], et cetera, is not the issue. I hear all the time, that knowledge is power. Then I counter that with, knowledge isn't power, unless you operationalize it. So until we take what we learn and put it in place so that it then impacts that population that we're talking about, we're really not moving the needle.

Evelyn Lewis, MD:
Maybe we'll find out that asking this question, doesn't get us as far down the line as we think so. But if we get that information, then we know we need to do more. If we never do it, we have no idea where we are. And so what I'd like folks to take away is, there is a critical need for you to take this on to honor that promise that our country made to folks who put that uniform on. And see what we [inaudible 00:45:42] to actually impact and affect the healthcare outcomes that these veterans and their family members have. And so if I could say anything, it would be, take this what you've learned from what we talked about today, look at what your organization is doing, and then understand how you can integrate it into that, so that you see some of those changes.

Evelyn Lewis, MD:
if you have any questions about how to do that or how you might approach it what kind of information is available, please feel free to contact us because we'd be more than happy to have that conversation so that we can get more people to health care and the healthcare outcomes that they deserve.

Chris Hemphill:
Well, hey, we appreciate those thoughts. And I'm going to think about this all weekend, especially this one phrase that you said, knowledge isn't power, unless you operationalize it. It's just potential energy sitting there, could be collecting dust unless you're actually doing something with that, that knowledge that you have. And we could put that as a challenge, not only to this issue at hand, but many things that people address, including that analytics domain, where there's predictions being made. But once we know something, once we have an idea, an understanding of somebody's risk factor, what are we doing as a result of that? So very powerful thinking and appreciate you coming on and sharing these thoughts with us.

Terry Tuznik:
Yes. Thank you so much.

Evelyn Lewis, MD:
Well, I thank you for the invitation and for sharing this with others, maybe we can see that we've made some [inaudible 00:47:24], so thank you again.

Chris Hemphill:
Thank you. Well, folks, that's the conclusion here and we're going to make a transcript available on our website as well as a recording of the video. So keep an eye out for that next week. As we move forward into 2021, there are other speaking engagements, other topics that we're going to be educating on, including AI in patient engagement, data ethics in healthcare, addressing racial bias and gender bias, other things like that within AI. So lots of exciting topics stay tuned with us and we will keep the information flowing. With that, thank you folks, and hope you have a great weekend.

Terry Tuznik:
Thanks, bye.

Evelyn Lewis, MD:
Thank you. Bye-bye.

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