Digital Identity and Wellness: Who You Are Determines How Well You Are

Good afternoon to all of you thank you so much for joining us today for our health professions educator health system science session i'm very pleased to introduce today's guest speaker dr kiel coleman dr coleman is an emergency medicine physician with carilion clinic an associate professor of emergency medicine with virginia tech carillion school of medicine dr coleman thank you so much for sharing knowledge with us today i'll go ahead and turn the rest of our time over to you great well thank you and good afternoon everybody thank you to teach in the school for inviting me to give this talk uh we're gonna cover a lot of material here we're talking about digital identity uh and how it impacts wellness more importantly around uh identity and autonomy you will notice that there is no cme offered today uh we usually skip over disclosure slides pretty quickly this one i want to spend a minute on because it's important for the talk so i'm the co-founder and cmo of an organization called archive core uh archive core develops uh credentialing and identity software in the healthcare and other professional spaces uh this is not a sales pitch uh or an investment pitch this is really an information session uh where i talk a little bit at the end of the talk about what we do as a company but that's not the point of this talk i'm also the founder of a company called knowledge uh knowledge works with adult learners specifically mid-career physicians uh that are working on board requirements so it's a didactic curriculum that we offer through cpep out of denver colorado uh i also part of a company called clear creek that does real estate as well as some other more esoteric type investments but uh that's why the cme is not a part of this today because of conflict we didn't want to trip any wires as i said we're going to cover a lot of material we're going to talk about technology both being great and awful we're going to give two examples of a purpose-built tech advancement or enhancement that has reaped great rewards for all users and then we're going to talk about when something is not purpose built how that has a wrong or incorrect audience valuation and what are the results of that we're going to talk about the effect of non-purpose-built software on wellness and ultimately workforce retention then we're going to transition to how this overlaps with identity and autonomy and how technology could support greater autonomy both in the present and in the future sense so we start each of these talks with the health system science wheel and i i love this graphic because i i'm always thinking of it spinning uh all three circles while the outside one well it's always systems thinking this one has some some interesting serendipity to it because if you look at the big arrow we're covering health and economics along with clinical informatics and health technology and while that inner wheel the second one spins around it just happens to be overlying ethics and legal concerns and that is right in the wheelhouse of what we're talking about today so let's get down to it and by the way as you listen to this talk i encourage you to think about how you might apply some of these concepts uh to your learners or to your work environment let's get to the work environment so this is not an emergency department you know i grabbed this picture from the internet i don't know who these people are or where they are even i don't even know the department but this is a very familiar scene these days we are living in a time when we're we're watching the collapse of market-based healthcare and yes we've had a terrible pandemic that has affected the way that we function across systems but this is more than just a respiratory mostly respiratory uh pandemic we're also seeing people that have not had the care they needed the last two years and now this tsunami of care need has hit us and we're now taking care of people kind of like we did in 1910 we're back in ward medicine uh my typical day now is seeing people only in a waiting room because of my all my ed beds are filled with people waiting to be admitted because they're too sick to go home and i don't have any other capacity for them you know i was uh on a shift like this not so long ago about a month and a half i was working with one of our very talented pas and this physician assistant just happened to be eight months pregnant at the time we were working in our trauma area in our academic center edie and uh she was going out to the waiting area and seeing patients and coming back uh presenting them and and working through uh their diagnostic pathway and trying to come up with their fees to make them better and hopefully get them on their way home but you came back from one of these missions out to the waiting area and it's about a 50 meter walk for her each way she comes back to her chair and she sits down very heavily and she's sighs like a big heavy sigh and through her respirator and her goggles she says to me you know this is unfun i've worked with this pa a lot we seem to overlap in a lot of shifts and i think the world of her and i think of her as a colleague and a friend and as i'm pondering what to say because this is that physician leader moment right that place where we apply those wellness scripts of you know you're not alone in this i'm feeling sort of the same way this is what i'm doing about it or there's light at the end of the tunnel or uh hey there's a yoga class at 5 pm today something like that i decided to reach for something completely different and so i said to her you know there's a pretty decent chance that your baby will have the opportunity to live about 150 years which is not what you usually answer in a a moment of wellness need but it's true and i wanted to drive home to herself to her uh that you know this is a tough time we're living through but we are simultaneously living in a time of magic and miracles we are in a place where children born today we can really consider that a century and a half of life is it's on the horizon it is a possibility and why would i think that well there's companies with lots of money that are striving for this right now i don't know how many of you have heard of calico if you haven't you can't be blamed cause they've been super secret calico is a spin-out from google you think well why is a search engine talking about mortality oh when you think about the folks that run search engines these are some of the richest individuals on the planet and if you're a super rich individual and you're used to a world where hurling money at a problem solves that problem and the biggest problem that you can identify is what you interpret as a short life of 75 to 85 years maybe that becomes the big barrier that becomes the big challenge for you and that's exactly what's happened at google approximately one-third somewhere around 32 percent of google's r d in 2019 went to life extension research that's it's an amazing amount of money that's being spent on this and i have no doubt that perhaps immortality isn't within reach but serious life extension probably is uh if you're interested in that stuff check out the calico site it's fascinating and if you're rich enough in the future hopefully we can all take advantage of it you know life extension isn't the only thing that that makes me think of magic and miracles i have something a little bit more banal uh that i get to pay attention to at home and that's scenes like this so i have a 13 year old and we are living in 2021 about to be 2022 which means with a 13 year old in the house you're probably going to be engaging with video games in some way so this is not a photograph from you know yosemite this is this is really a game setting so in open world games or these incredible landscapes that you can trace across and i remember video games from when i was 13. it was a quarter that you put in the arcade at the beach and uh you got depending how good you were somewhere between two and 20 minutes of play time in a two-dimensional environment that today would look totally archaic but uh at the time was was entertaining for a few minutes i was 48 when my kid asked for the first open world game and i opened it up and sat there stunned and i literally stunned i sat in a field in an open world game somewhere around five minutes just watching the breeze and hearing insects fly past and watching the wind on waves that worked with what looked like real physics i was blown away but as my kid will tell you i'm terrible at playing games i don't spend a lot of time with them i do spend a little bit of time though studying the companies that make these games and while you may not recognize them perhaps you do but if you don't ubisoft gorilla ea sports rockstar back division if you put these together their market share that means the money the the actual equity offering from these companies um and you use just their user touches how many people are interacting with their platforms at any time these companies combined are greater than music streaming and movies combined so all that stuff you see on netflix prime uh apple tv plus anything you see in the theater plus anything you hear on spotify or pandora or wherever you go for your music there's more people playing games than all of that i think that's an amazing number and it says something about where we are today in terms of interactive software i think the tech is super cool i've already waxed a little bit about how beautiful i think they are i also think the idea that you can plug real physics a gravity well into anywhere on a three-dimensional screen and actually have something an avatar fall at 9.8 meters per second squared reach a terminal velocity that doesn't make everybody in the room sick it's it's incredible uh they are really on the forefront of making a virtual universe but that's not what's super cool about gameplay i think ubisoft in particular has been the most public about this they engage in something called player motivation which every software company does we all interact with our users and we're constantly doing customer evaluation ubisoft though is taking this to a new level so there's eight different corporate sites for ubisoft montreal being the biggest and each one of these sites has 20 or so psychology trained coders that work on how do you keep users engaged with the software how do you improve their experience how do you get them in line for the next product that's going to be coming out and make a satisfying experience uh as folks waste time on uh on playing games it is an incredible amount of corporate effort to create a motivation section within a company now let's contrast that with another company i play this game every day and i'll tell you it is the worst video game i've ever been on but epic epic does a great job for what it is designed to do uh i'm not slagging on epic for being a bad video game i mean we all recruit our views evidently those are the winning points but epic is not what we and when we say we i'm going to to say clinicians thought we were getting into when we flipped that thing on for the first time it constantly has add-ons that are trying to improve our experience improve the care of the people we're serving um and yet it always seems to miss the mark just a little bit for instance me two years into a pandemic when i want to order a rapid pcr test for the covet 19 uh virus it's a total of 12 clicks now for me to put that in um still and that's you know some of the 4 000 clicks that evidently i do every shift according to account um and that is with the help of a scribe who's taking down the hpi for me it's like epic is is beautifully designed but it's designed perhaps for the wrong audience this was not purpose built for us if you're a doctor a pa some clinician who is interacting with this software you have to think these people when they designed this multi-million dollar platform they must have just missed their user base and they're always trying to catch up and i would argue that no they were exactly on target and remain on target for who their user base is because you need to know and and most of us do already that epic was not designed to be an electronic medical record we call it that but epic was really designed to be a weapon in the arms race that is part of the provider-payer war so when cms requires you know that review of systems we actually need to see 11 points in there to get the highest code possible well epic will answer with a macro that you then have to fill out and hopefully you do each time but speed demands that we just plug those in and maybe they may or may not add anything to the actual history that we get from the chart what we wind up seeing then is that you have the highest skilled most sophisticated highest paid employees relegated to being data entry machines because we're interacting with something that is not purpose built to improve health care or to communicate well between physicians patients institutions rather it's something that's there to give credit and to challenge the rejection of costing that we might see each time a chart is turned over to an insurance company now we've skipped over the chance to have an emr that functions to improve car care we can all recognize that the days of your when you had a piece of paper in front of you and you're sitting in an office you're scribbling probably something illegible uh about the patient that you've just seen and you're trying to draw for your memory that three articles that you're able to digest last month and see if they apply to the person you just saw those days are gone and they probably should be we're way past that i think epic does a heroic job at trying to make the move to the next generation but it can't because it wasn't designed to it wasn't designed to be the thing that has natural language processing with speech and colloquial term recognition it's not a database of diagnoses that can synthesize the patient's complaints and the 10 000 articles that are available to talk about what might be going on with that person it doesn't then re-engage with a physician to look for what is the most ideal therapy for that person based on their health their age their comorbidities yes even their financial status it's not a communication hub where physician and patient are augmented with the ai to reach a consensus about what is the best course the chance to build that that opportunity has has left us there's too much investment in a purpose-built platform that really is down to counting rbus it's gone so what we're left at is we've made a cash register that was not really a decision rather it was the best course for the moment and that's what our emr has been reduced to as long as we stay addicted and i say use that word addicted i was at a management a medical finance and health care administration conference two weeks ago um and there was a a person at the podium that was talking and uh he caught himself for a moment and one of his colleagues on stage said no go ahead and say it out loud he said you know fee for service is crack and we've been on it for about 40 years and it's really really hard to rehab people off of it but as long as we're in a fee-for-service environment we're going to need a tool like epic it is not purpose built for making people better it's purpose built to secure the mission because we've all heard it without money there is no mission we're seeing the fruit of this decision that had to be made today unfortunately you know we've lost somewhere around three quarters of a million of our country people to a terrible pandemic there's waves that come out from that big splash of of mortality uh i'm very worried about the disability they're gonna be seeing but we've also seen another set of casualties and that's in our healthcare workforce we are watching people leave in drugs and it is alarming to me to watch nurses that i've worked with for years that say you know i've found something else they're not looking for another nursing job they're looking to to leave this um i i get a little depressed and a little emotional about it because uh these people are my colleagues my friends and frankly the environment that i go to work in each day it's changing radically now there's a whole lot of business literature out there right now talking about okay what is this going to cost us to get back a workforce there's a heavy amount of that literature that's saying you know money may not be all there's a great study that was uh republished about a month ago out of pittsburgh where they're looking at people that had left a job for some place with a greater salary and maybe you know this uh maybe you've heard it before but uh it was it was news to me that if you leave the greener grass and that greener grass happens to be a lawn made of hundred dollar bills um you're going to be really really satisfied with those hundred dollar bills for about two pay periods and then the luster is gone and the things that perhaps you saw wrong with your elected profession those still float up and there's still a problem maybe you know those interactions that you had both with the patient the emr maybe your colleagues well those things seem to resurface again and that money is not the solution to all of life cells it's a critical part of part of the shift that we're seeing in the workforce but it's not the major answer so what is it that people want and i've just said that money isn't the thing but i'm going to tell you the things that people want actually have a greater expense they have a greater expense not fiscally but culturally so they want clarity they want to know what does it take for me to be a success in this role into which i'm being hired what are the tools that are needed and why am i being provided with those tools is there a career path ahead of me is this it is this kind of where i stay until i cash in retirement at some point in the distant futures you know supposedly in my 60s maybe or is there a step up somewhere and do i have support for that how many people before me have actually trudged down that path and have actually climbed that hill they need solutions that include skill development programs it's not just enough to be the clinician that you are today it's who am i going to be in the near future and then you know in the 60 month 120 month future downstream it's one of the things that i love about emergency medicine and more specifically my department um i went to medical school late came out at 40 out of residency and but a lot has changed in the last decade or so and i'm lucky enough to be in a department that keeps providing me with tools to show how the specialty is changing and to be on the best practice sharp edge end of uh that training so you know doing regional pain blocks that was huge for me those sorts of training uh opportunities uh and workforce planning input where you know what we're gonna need more of these people that are ultrasound gurus really soon that kind of input is what people are asking for and that is a huge ask beyond the money that's needed to secure positions in today's healthcare environment let's switch a little bit then to talk about that motivation beyond what the workplace has to do but more understand what we need as individuals i am i have no interest in the book drive i don't know mr pink it's a very quick read and it's one of those business books it's just like any business textbook you think it's a good book when you agree with what it's saying so i agree with what this guy is saying and it made a lot of sense to me he talks about intrinsic motivation with three components autonomy mastery and purpose we're going to talk about autonomy right now and what that means because i think it's a critical part of that need that our workforce has i'll go back to games for a second so mr pink in drive uses the an example of that game company i'm fascinated by this project because it's it's so simple um on its face at least uh that game company was started by two film school graduates of the university of california and these were not folks that had seed money from friends and family there was no big angel fund they took a credit card and with ten thousand dollars launched a game called flow and flow is the simplest of games uh it's an oceanic environment you start as really what looks like a single-celled creature this avatar that you drive around there's no competition there's no driving anything fast there's no blood support involved no guns nothing like that instead this avatar floats around this oceanic environment and it picks up nutrients and sometimes will combine with something else that might look a little bit like a single cell organism and what it's doing as you're just floating around this environment it's super relaxing by the way and beautiful but you're evolving and that was part of the focus of the guys that created that game company was they wanted a work environment that didn't look like anything that they were seeing in the job offers they were getting as they left their undergraduate careers and they now have a company where people can do what they need for success for instance hey we're going to have a download of whatever uh game they're working on on april 1st it's february this is what we're asking out of you these the tools you have go do it well do i get an office do you want an office sure you can have an office do you do i am i at cubicle farm do you like that have at it can i work at the beach go do good april 1st though this is the product that we need out of you and you let us know what barriers you have between now and then and we look forward to seeing what you create now that's not realistic in healthcare it's really really difficult to have a wide open autonomous kind of platform uh and you got to think these people are in pretty fertile soil with some really great seeds to plant with i mean if you're looking at caltech and ucla ucsd as the people that you're recruiting in your game company well you're going to do pretty good you can also give them a little bit of trust but that trust that example they've used or demonstrated i think is is something that we might take a lesson from and perhaps put forth into our environments so autonomy that's where you're trusted to function on your own autonomy and identity often are used interchangeably i don't think they are the question today this is from the journal of medical ethics it's been quoted dozens of times that's why i have a citation from 2000 still up here the question is no longer how do you want to exercise your autonomy like in that game company program anywhere you want it's how do you define yourself and i think for health care this is a lesson that we can really use so if we're going to define ourselves we need to know where we are defining ourselves i'm going to call this three faces of identity and by the way this is the world according to king coleman right now uh while we have evidence and this has been talked about a bunch of different venues uh these are mine so let's start with them the first is is you uh as my kid says your 3d life or she'll also say irl which really worries me sometimes i'm sitting at dinner are you in real life right now or am i talking to my virtual daughter but this is the person that people see in three dimensions and those people of course might be your companion could be a spouse a romantic relationship maybe just a good friend your kids your family it's the people in your work sphere and then also in your community sphere and that could be your social life your friends maybe it's in a church maybe it's in some other community group but if somebody asked you who you are you'd probably still identify you the person that's sitting here breathing air that's you know 760 millimeters of mercury the next one is what's gotten a bolus of attention over the last few years um but i really believes is a second-class identity and this is you and the network so are you on a platform so that's your instagram facebook twitter world and how you shore that up there's tons of coaching about who you're supposed to be uh in a networked atmosphere today that network atmosphere is part of our greater work geography i had an article come out a couple months ago and the people that i worked on with i have never shared physical space with which is kind of amazing and yeah people have done this for decades by phone or by fax but this was a very fluid relationship where we could live time edit online and then come up with a product that we're all proud of and we're able to send it off to a journal it's your influence fear people that will listen to what you have to say or the people that you're listening to i'd argue that this is also the folks that you patronage so amazon is part of your network sphere if you don't think that your amazon buying habits affect your search engine well you just haven't been paying much attention lately um but when that search engine gets affected so does the way that you interpret the rest of the world so your network self is deeply engaged with your consumer self and then if you go to the next level you don't just read the commentary behind articles but you're one of those brave people that actually post something there that becomes part of this identity and unfortunately i could make a pretty good guess that whatever is said in that commentary would rarely be what that 3d person says the dinner table we could all hope it would be but often there's that mask of the network self that doesn't reveal who we really are this takes us to something that is largely ignored and that is the professional self and today this professional self we think of it as our titles our role in the work environment uh perhaps that position that you have within an institution it's developed through your scholastic accomplishment you know where did you go to undergrad medical school residency was there a fellowship what cme what other graduate courses have you taken what certifying agencies really believe you so are you actually carrying something from the abms under your board what is your work role uh and how is that codified is it just a lie in your cv or is there some merit badge that goes along with it there's also the legal framework that we all have to function in uh around state agencies and the dea and i'll tell you that that professional self identity uh with the easiest to read uh kind of lay person's translation through a cv tells a lot about not just who you are now but who you are going to be um i was recently on a search committee and got schooled uh educated that you know when you're looking at these collections of credentials people that seem like they're equally matched are actually going for very different roles there are cues within a cv for something like a dean versus supposedly a chair you know one is looking at philanthropy the other is you know very operation-centric who you are in your professional identity uh credential stack tells a lot about not just who you are today but who you will probably be today we better purpose build an identity if we do not it can be done for us we've already seen the emr move into a place where it had to be and part of the arms race of payer provider war but under professional identity we're seeing an employment crisis uh or a labor crisis in part because a lot of people actually don't own who they are professionally and there's a way to codify this we're going to talk about this in a little bit of detail in a second you know a couple of centuries ago this is a whole lot easier when there are really just three learning professions that was the clergy the law or medicine and the truth was these people enjoyed autonomy not because of the role of being learned while they may have been the only folks that might be able to read and write in a given community they also had some other support this these jobs were often avocations these are people that usually came from some means while there are stories of people you know raising themselves up from poverty through education they were actually pretty rare up until the last 150 years or so so people that were already functionally autonomous because they had some position uh land and or money behind them they could then be you know professionals because they had a little bit more education than everybody around them but they are autonomous not because they're profession probably because of who they were before the world medical association is has a pretty interesting eye on the idea of profession and autonomy today and they say in this quote that uh you know professional autonomy is is really something that is self-serving yeah i think that's true it also is governed by an evaluation by other members of that profession i think this is where in some ways we have lost our way that no longer are we the people that are judging others in our profession instead it's a whole lot of other actors around easy targets for that would be patient satisfaction scores and i can still argue that's part of quality uh and it's part of what we're supposed to be doing and perhaps another member of your profession looking at you and your view on quality or how you're taking care of folks that's probably appropriate for them to look at is it something that should threaten your employment not so sure i think places where we have fallen down is in the idea that everyone who comes out of medical school and out of residency and then is on a medical staff is bulletproof and that they can't be looked at critically um i think in my institution we do an excellent job uh with peer review uh it's taken very seriously but i'm not sure that happens across the country if you listen to dr death or are familiar at all with a christopher dunch story you can see this is very easily a place where institutions fall down and that the idea that physicians monitoring and then enforcing the roles the profession maybe we haven't done the best job uh over the last 50 to 100 years and now we're paying the price for it but autonomy is still something that is judged and evaluated by other members of the profession but who holds these things so that professional identity stack that i was talking about many of us have sheepskin on our wall or something else that denotes the schools you went to the degrees you achieved and perhaps in your mind you're convinced that's me and that's all you need to see well we very rarely actually interact physically in a space where those can be on display there is no proving edge of the patient rather we depend on credentialing agencies to hold those credentials to digest them to evaluate them for is this person competent and safe in what they do which means that pretty much as soon as you leave training you no longer have control of that identity but who does it belong to them is it your school is it the training site or is it the group that's actually going to be using those credentials to bill under your name like a hospital who owns this stuff i'll tell you that it's fairly fluid fairly liquid right now in the current state anyone can add into a credentialing packet there could be some verification but i think if you pulled physicians around a table and said hey do you know what's in your med staff file right now most people would shake their head no because it's really the last thing it's way at the back of the mind uh way behind your patient care your continuing education oh yeah and then your real life what we do here in an institution what we have as far as credentialing and and med staff world um it lives in parallel but really pretty separate from who we are what if instead we had a paradigm that looked a little bit like this so you have some data something that's in a text and to get into that data there was a key for it you use that key and all that data suddenly is encrypted and so you have a hash if you will of a given set of data perhaps it's your cv perhaps it's your procedure logs uh maybe it's you know the insurance companies that uh are actually in network for you whatever it is um that can be unlocked as long as you share it with somebody and then that decrypted data becomes part of a file that belongs then to an employer so a modicum of autonomy around that identity packet so that looks a little bit more simplistically something like this this is a very early iteration of what we were doing at archive core the deal is you had an institution on the left a hospital that's a training site and you could download and encrypt you hash a bunch of data you put it to a distributed ledger that ledger then is readable by anyone anywhere they can't decrypt the data unless they have the key for it but anybody can see that keel coleman graduated from this place at this time this is the ip address that put it in this is the human that did that and uh here's the transaction and you can verify that and make sure that it's validated from any site that interacts the world wide web well that seemed pretty nifty until i started thinking about who is missing here you know if the goal was to provide a element of sovereignty over your identity we really don't have that here which makes me start thinking about something completely different which is nfts so same line keep it in mind we're talking about identity the professional identity of a stack of paper that you have that you carry around with you it can be decrypted uh on a chain by an employer but it skips you but what if we had something like a non-fungible token and if you pay attention to the news of the past year you know this is the big finance storm so people will pay evidently 69 million dollars for a gift uh that yeah anybody can download anywhere but if you own the first copy of it it's super valuable great story and it has nothing to do with what we're talking about here instead i want to talk about what is an nft so fungible nft stands for non-fungible token so fungibility so if i have a quarter and my friend tom has a quarter and they're both minted the united states they're the same year they look pretty similar well we can exchange those quarters and we both have uh we suppose still hold 25 cents that is fungible back and forth now let's say tom has a quarter that just happens to have oh i don't know a battleship on it and that's the only quarter that has a battleship on it and it was minted one time and it still says 25 cents currency in united states dollars but this is a quarter it is not a quarter like i have though we cannot exchange those because there's an external agency that says tom's quarter is worth a great deal more because of its rarity we would say that those tokens are non-fungible now he might be able to spend it but i think that would be a very expensive bottle of pop that he bought with it anyway that's the 721 non-fungible token i use that term i'm not going to get any more detail around it but i will tell you that there are multiple other uh processes and protocols that ethereum has come out with in the last year that do some different things than just a single token that is non-fungible that would be worth its use a single time if i was you know let's say hashing a diploma great that's my diploma token good for me i've got it and i can show it to other people and hopefully they can look online and say yep that's more secure than any other way we do it let's use that makes you start thinking about is this something that's actually uh transportable can we take it to different places this is a digital idea that follows me around do i even need to carry a card anymore or as i learned at an airport a couple weeks ago you know are my iris prints or my fingerprints enough to carry the data say that keel coleman is who killed coleman is because that's kiel coleman's eyes that we see don't know more importantly what is the data that goes along with whatever that identity marker is be it a card be it my iris or fingerprints what is it that's in my identity packet that i can carry from one place to another and actually have that is fungible so the idea of a professional nft and this isn't far out we have seen nfts now for deeds on houses for um financial instruments for whole um funds so you can buy an nft that marks a fund uh a mutual fund for instance uh and you hold on to that and that's that place in time the moment you bought that fund uh you have it for keeps um you can sell that nft by the way for a certain amount of value if you did that with a professional identity you could have a single token if you will and you get if you're using the current protocol you get to add some stuff to it all at once and that becomes the token one time now in full disclosure archive core has patented a way for it not to be that one time but to have an nft instead that is buildable that means that your new license by the state you're practicing in or that new board certification or that ongoing professional practice evaluation each of those items can be added into the current nft and they can be tracked at any time they can be looked at by the employer maybe by a future employer and they can be tracked by the person that actually holds them now permissioning for these that's going to be a very interesting conversation about who gets to put in what but that is developing as we speak we are in the middle of purpose building digital identity because that is the key to our autonomy in the future state i believe that part of the strife that we're seeing across the health care continuum is a loss of autonomy and this is one way where we could shore up uh that leakage that we're seeing across our nation so that's a lot of ground to cover so if you're looking at technology it's got to be constructed on a foundation with the intent that's going to do the greatest good for the right audiences autonomy is a required ingredient to work force retention and that has to be manifest both by the goals of the employee and what an institution needs when they bring somebody on this is a trust and or how we call it an emotional contract that we need to start making with healthcare employees sovereign identity is a manifestation of professional life and it is one that is slipping away from us now there are pathways that we can choose to follow in the future we've got a few minutes now to uh answer some questions i'm going to stop sharing and let's see if we've got anything in the chat any questions so kale this this has been a great talk really gets the old gears um turning in my head um i wanted to hear from you what things you think that we can do as either individuals or as an organization as leaders um to make the most of uh things that we've learned through this conversation yeah so thanks sherry um i think the first that our institutions uh both of them already have a mindset that is directed toward seeing what has happened across healthcare employment let me say that first i think what we're also going to have to have to look at though is what are people needing in the future i think there is going to be a financial component to this but more importantly as we start to recruit uh new folks in and i'm talking about across the continuum this is uh our physical therapist our cnas our rns uh our environmental health folks what is it in a role that will make you more fulfilled i know this is a job to keep something on the table and keep the wind off but what else is there what are your goals the future and how can we help you reach them um i think that we could do a lot more uh [Music] to do that can you touch on on ways to protect digital identity um yes so uh when we talk about digital identity if we're talking about the professional identity component i think that uh today it might be a good idea for you to make a lap and go back to the places that provide your primary source verification uh and i'm talking about your your school uh and your training site and perhaps prior employers and see what they've got and if they do have a record of you how is that being protected ask them and then asking for copies that have some hash associated with it something that shows this is time stamped many institutions are on a distributed database we're working on a way for individuals to be able to do that to be able to hash documents that they've been provided by their primary source venue and then put it on chain i think the distributed ledger with its immutability and its consensus algorithms are probably the most secure way that we're going to be able to keep documentation in the future so who's going to set up this platform that promotes the highest good for all involved well preston that's you it's actually going to be all of us we're all going to have to be influencers in this world now these are going to be shards uh tiny segments of the future state in which we're going to be living and we're going to have a sphere of influence and i think that idea of the 20 feet around you is your your greatest fear well it's going to be what does that 20 feet mean to you um we have to do some serious customer segmentation here uh and then customer evaluation segmentation is how we decide what is really the highest good for all involved and sometimes that's by a majority unfortunately we've had a whole lot of decisions that have been made really for what is going to keep us financially uh healthy and that's become the end game i think in so many of our decision points uh and unfortunately it's been somewhat self uh somewhat short-sighted uh we've got to look beyond that and say what is this community going to look like in 20 years uh not what's happening today um yeah yeah what other questions dr coleman i have a quick question for you um so when we're thinking about our future learners our future medical students who are coming to us um many of whom are very tech savvy um because things have just really and there's so much more at their uh disposal in terms of technology what are some ways that um as an educator we can help them uh think about the ties to some of the things you've talked about today and their future in terms of their career paths yeah i think i like that question because it uh highlights something that i think about all the time that is that i'm getting older every day i i only realize that in my 50s um and and what a completely different world i live in versus that of my 13 year old daughter and i think that the folks that we're bringing into medical education today first off i i stay in this job because i'm stimulated by them i'm inspired by them uh and sarah would you point to how do we communicate with them if we're actually you know occupying wholly different continents in terms of experience um i think the danger for today's learners is perhaps if you're not in the digital world well then maybe what you have to say isn't worth much so maybe it's our responsibility as the older generation to first off uh become a little bit more facile with the world in which they're occupying i think the easy answer and probably the incorrect answer is engage with their social platforms i think that's a loser when we look at you know platforms that change over every 90 days to every six months trying to keep up with that just becomes this hamster wheel of oh my gosh i can't seem to stay hip enough to be on instagram if that's even the thing today instead i think we need to find out what are their motivations for engaging with these digital platforms you know what are your goals asking that uh of learners hey why are you on that thing why are you posting this and that's hilarious what is tomorrow and your tenure your 40 year old self gonna say about that we have to we have to be a little bit protective without being the boomers they all fear that we are um [Music] i think that we have a responsibility though to become a little bit more savvy about what security looks like in that future i think that first question can you touch on ways to protect digital identity what are the security protocols going to look like in the future i think we're probably about 15 years out from having serious quantum security conversations um and i say 15 it's already being done today but 15 years before we really see it uh writ large having a handle on how people are going to secure their identities you know those 22 year olds that we see today you know at 35 what are they going to what are the tools they're going to need and how can we set them up for success as they make a transition into that world and that's stuff that we can learn today and help educate them about most of them are so savvy already they uh they don't they don't need our help okay how do people who have privilege with certain platforms for example youtube gather info on others i'm sorry i haven't i'm not sure i i understand uh the question is it um when you say privilege on certain platforms does it mean that you're posting or um feel free to actually unmute and speak up rather than trying to get it across in the chat through cookies sarah i don't know if there's a way to unmute this person and maybe yeah if you um if you can't unmute yourself you could send us a note in the chat and we'd be happy to unmute you if you would like for us to do so and then maybe while we're waiting for that question um i have another another question for you and this goes back to the very beginning of your uh conversation today with us when you're talking about open world gaming i mean when i think about that um of course my mind starts saying about all the possibilities that that we can do uh with that to encourage um health and wellness for folks who may not have access to outdoor activities or who may not have access to you know going outside and and being a part of nature um so do you are you aware of any um use or any um anything in the works um where we can take open gaming open world gaming and integrate that into um mental health and wellness yeah i have read about platforms that um that one i think it's a platform that was designed around adhd there was an interactive uh therapy platform for children uh where they are stimulated to their speed their adhd speed and then are taught through it which is a a really interesting idea i think that game play has tremendous uh possibilities uh for education uh and also for therapy i think that's one that's the one example i can really think of um i really have no interest in them at all but i'll tell you that from a wellness perspective that game company uh by the way you can download these things for free in ios just putting it on a phone in terms of a meditative experience they have nailed it um and i i would encourage anybody to at least take a look at their site just to see if you might be able to uh avail either your colleagues or your patients uh to some of the offerings that are there but i think that we have a we have a bright future in terms of okay where else can people experience you know what we are lucky enough to have outside our back door you know if you're on the lower east side you may not see mountains too often unfortunately a lot of these open games uh do have a competitive or even violent streak to them that's not not always appealing but i don't think that's the end game for most these companies i think they will be building things that are better and perhaps a little bit uh more appealing for somebody in a healing world there's just a lot of opposing forces to what you want to do uh the system that's set up now is so uh all-encompassing i just i i certainly agree with your idea that it's going to take 15 to 20 years to see some change i wonder if you have any other ideas about how to move things forward yum thank you um exactly uh you're you're spot on what we've learned over and over and over again is that introduction of some giant even if it's a multi-million dollar funded package some giant software solution of the world that is going to be a loser every time uh we on the ground are going to have to participate by making incremental change to build a future uh our efforts and uh my startup are just that these are an incremental improvement to a process uh that right now is inefficient doesn't really serve anybody terribly well so around credentialing we made a single improvement in our current package and and from from my view that's the way that real change will happen it's going to be tiny increments that lead up to um you know what looks like a new world um eventually there will be big actors that will have to come across with something that replaces something as large as the current electronic medical record but that's going to come after a tremendous cultural shift that we may be on the threshold of uh over the next five years or so but for right now i think it's going to be tiny changes that uh lead the day thank you so much dr coleman um this has been a fascinating talk um and a great uh get you thinking talk so thank you for that uh please uh any feedback is uh valued either through the tech page the qualtrics survey uh or email me directly uh always happy to hear the good bad and ugly i'm unemotional about this stuff and i appreciate your input thank you absolutely thank you everybody have a wonderful rest of the afternoon and the rest of the week.