Episode 2: Empower Hope

Cara Lunsford (00:00.233)
the awesomeness that's about to come out of this interview.

Cara Lunsford (00:09.569)
Well, we've got Dr. Finley Zachariah with us. How are you, Dr. Finley?

Finly (00:16.12)
Good, good. How about yourself?

Cara Lunsford (00:18.023)
I'm really good, I'm really good. Did you have a good weekend?

Finly (00:23.874)
I just, yeah, with the family and that's always good. So in the pool. Yep.

Cara Lunsford (00:28.63)
We did a lot of In the Pool 2. It was very hot out here in the valley. was very hot. Whereabouts do you live?

Finly (00:36.098)
Yeah, Inland Empire. So it's even hotter.

Cara Lunsford (00:39.855)
that's really hot. That, my gosh, Inland Empire. for the listeners who don't know, that's Yes. Yes. So, all right. Well, I am very excited to get to talk to you because you and I, and also your business partner, Chris, Halsema.

Finly (00:43.95)
Yes.

Finly (00:50.244)
Yeah, yeah, pretty much desert effectively.

Cara Lunsford (01:07.819)
I've been talking for a while and you have been working on something that is pretty transformative, I would say, for the healthcare industry, especially in terms of end of life and kind of really getting prepared for that and helping others and clinicians and hospitals identify that kind of thing earlier and have...

the proper interventions, I guess, would you say that that's right? Like that we're intervening appropriately and timely? So I wanted you to talk just, A, give a little intro about yourself, just personally, like a little bit about who is Dr. Finley Zachary. And then let's like jump into Empower Hope.

Finly (02:02.66)
Sounds great. Yeah, so I'm a family medicine clinician and then did training in hospice and palliative medicine. And I've actually been at City of Hope, oncology, cancer treatment hospital for the last roughly 12 years. And so kind of in that time, I initially started out predominantly doing just clinical work, seeing patients day in, day out, most weekends. in that journey, kind of realized that

almost it doesn't matter how much I do in a sense, there's always more to be done for patients and there's always so much need that is out there. And so that kind of helped me transition into more systems and looking at what can I do at a system level to impact many, many lives, even beyond the one -on -one interactions that I have had and continue to practice on a clinical level individually. And so then that kind of shifted me into more kind of quality.

systems and then also on the informatics side as well too. Working with a lot of our technology systems within healthcare systems. And even within that, it still felt like we weren't doing enough and we weren't going fast enough in healthcare. And that kind of then prompted this journey to create a startup called Empower Hope, where it was, even though we have some of the best intentions in healthcare.

sometimes systems and health institutions are limited in terms of what are some of the near term priorities and how do we help kind of move with speed effectively based off of all the other priorities that are going on. And just recognizing some of the needs that patients have through serious illness, especially around the end of life and some of the mismatches that were happening. That was what kind of inspired Empower Hope to be born.

And then I guess a little bit about empower hope. So empower hope is a startup really focused on trying to harness AI to enable person centered care. And so some of what we try and do is, is to really try and capture patient preferences. A lot of times in medicine, it's about, you know, you have this disease, we have, you know, this specific treatment for it. Let's just go ahead and do it. And so it's, it's almost more of a reductionistic. Here's a nail. have a hammer. Let's go ahead and use it. It's like, well,

Finly (04:25.336)
we really should be thinking about should we swing that hammer or when should we? And even if we start swinging the hammer, then when should we actually stop or pivot that course? And so the key in our mind is that patient preferences are oftentimes not brought into the healthcare journey. And or if it is, it's not done in a systematic way that really makes it accessible for healthcare teams. And so that's where we have solutions to try and capture patient preferences and things like.

advanced directives and physician order for life sustaining treatment forms, as well as them thinking about, you know, how do we surface some of that information to clinicians? And so we have AI models that we've licensed that we've actually worked on, but licensed from institutions to be able to then understand when are those patient preferences appropriate to apply in the healthcare journey and have a whole kind of suite of solutions to be able to help.

clinicians and think about what are the decisions that might be appropriate at this time in a person's life.

Cara Lunsford (05:30.669)
Yeah, I'm a big fan of the Empower Hope model. mean, you and I have spoken. We've had conversations that have been probably more intimate where we've worked with a family together and talked about end of life. A patient that was very near and dear to my heart who passed away. And you really jumped in.

and were so willing to consult and talk to that family and understand what the preferences were. What are the preferences of the patient who had started out as a pediatric oncology patient, but by the time she passed away, she was already 18 years old, but...

I love that what you're trying to do is take something that's so important to you personally and trying to scale it so that it kind of takes you and puts you into every situation in a way, right? Because with technology, with AI, with all of this, it's like you can kind of take something that's really meaningful to you.

make sure that it is accessible to every clinician, to every patient. And that's what I think is really fascinating because I know in my experience,

You can't always, it's hard to teach certain things. It's really, really difficult to teach certain things. And so sometimes it's great when there's a piece of technology that can prompt and help, especially with certain conversations and things like that. So what I would love is let's talk about, you know, real world application.

Cara Lunsford (07:44.161)
right, of this type of technology. Because I think like when people are listening to this, they're like, and I don't care if you're a hospital administrator listening to this, or if you're a patient, right? You're the, you're kind of the consumer.

or you're the nurse, right? Or you're the doctor. You wanna be able to see like, does this affect my day -to -day life? How is this a good experience? How does this change the life of a patient? And how does it make it better for the hospital as a whole? How is it a cost savings tool? How is it like, because we know that things get adopted

by large health systems when it affects the bottom line. We just know that. We know that that is a true statement, right? But at the end of the day, you also wanna make sure that the end user, the consumer understands, why is this important to me? Why should I be advocating for this? Why as a patient should I be walking in and ask my clinician team, do you guys use Empower Hope?

Cara Lunsford (09:02.807)
Right?

Finly (09:02.978)
Yeah, no, absolutely. Yeah, thank you for that. Maybe to give a couple scenarios, perhaps, I think may help make it a little bit more practical and tangible. you know, one, I would say for a lot of the work that we've done, it's one of the near -term opportunities is end -of -life care. And so even though that's not necessarily where we see the larger vision of Empower Hope, we see ourselves

working across the entire spectrum. One of the greatest areas of need is really that end of life space. And so, you know, just for many national surveys that are out there, a lot of patients will say, if time is short, know, great, the hospital is nice, but honestly, that's not where I want to be. I want to be with family. I want to do, you know, other things. I want to go to Hawaii or whatever they'd like to do. And yet,

on the front end, what happens is if you have cancer or congestive heart failure or some other serious illness, at that point in time, it's usually I want to go ahead and pursue any therapy available. There's a lot of advancements in technology and trials and all sorts of other things. And so the hospital and the health care system is usually pretty good at capturing preferences at that point. OK, great. We understand this disease that you have.

We understand your preferences are to go ahead and try and exhaust any available therapy that you have here. Let's go ahead and start going down that road effectively. What happens then is usually there's not a reevaluation of patient preferences. And so how do you then recapture that same patient who says, yeah, I absolutely wanna try clinical trials. I wanna try other types of advanced therapies for this disease. But I also, again,

don't want to die in the hospital. I want to actually be at home with family. I want to, you know, do certain things at the end of life. And so what empower hope allows for is basically to say, you know, even if you are going through some of the most advanced therapies, which we want patients to have access to, we also want to make sure that if patients have comprehensive preferences, that we're making sure that they have a reevaluation time point within their illness trajectory to be able to say,

Finly (11:27.202)
You know, now I do need to make some more harder choices. It's not just I have this disease. I want to go ahead and start therapies. It's the doctors, you know, think I may have a few months, perhaps with the help of a tool like empower hope is is going through for the therapies is going through the next line of therapy. The right thing for me or given now it's just, you know, perhaps a very limited time frame. Maybe I do want to make different choices for myself and for my family.

At this time, and so that's I think one of the biggest kind of end of life opportunities where we're not trying to, you know, change people's minds. We're not trying to, you know, shift people to say everyone should have hospice or comfort or inter preferences only. It's really understanding who this person is, what they value and how do we align therapies with that? And for the majority of people again, that's how do we enable comfort and preferences up in life?

for some patients is gonna be, we wanna continue therapies and life is important at all costs, even if I can't communicate or even if I can't necessarily care for myself, if my heart's beating, then I want to continue to exercise therapies within medical limits effectively. On the front end though, just scaling it earlier, I think the other opportunity becomes

Cara Lunsford (12:49.463)
Yeah.

Finly (12:54.488)
How good are we in medicine? And I think we have a lot of opportunity to say things like, know, again, who are you and how do we help, modify things? And so if it's, I love to play piano. think we had talked about that example, in the past where, you know, we actually knew a couple of people who, knew, really, really gifted pianists and then they had cancer and then they had therapy and they actually got neuropathy.

And so now they weren't able to play piano in the way that they used to love and enjoy, which was a huge impact. And it's, if we understood that about the patient, could we have actually pulled in the need to have, you know, really fine motor skills and preservation of that as a key factor in deciding any therapy plan for this patient? Or if it's you're on, you know, these cycles of

treatment and we know that for the first week after a specific therapy, it's going to actually make somebody feel really, really crummy. they're to have nausea or other kinds of things. And they have a key event, a wedding or something else, you know, in that, time period could we actually know that about the person and then be able to provide decision support to the hospital to say, Hey, this, this really important event is here. We generally understand the therapy and the side effects of it.

Can we just shift that regimen by a week, by a few days here or there to be able to help make sure that the patient is feeling the best and able to participate fully in what's meaningful to them?

Cara Lunsford (14:33.591)
You know, sorry, I'm.

I feel so, I'm kind of overwhelmed, like in an emotional way. In an emotional way, I feel so overwhelmed because A, I think as a nurse, this is kind of like, this to me would be like a dream come true, really. To be able to have that kind of insight, to be able to advocate for patients because

you have that knowledge because it's been put in front of you. Because what we know is that we're so

We just don't have enough time. There's so much data. There's so much to look at. There's, you know, if you get a chance to look at someone's H &P, boy, you're lucky. Like, you know, it's, did you get a chance to fully read the last, you know, note from the last shift from the, and.

I think that the idea of being able to utilize technology in a way that allows you to explore the art of medicine. had probably one of the most beautiful conversations, which is our season finale for season four, was with Dr. Rob McDermott and he did a TEDx.

Cara Lunsford (16:09.247)
a while back on the art of medicine. I'll have to introduce you guys because I think you'll have a lot in common. he really talks about just being able to do the type of care, being able to provide somebody with a warm blanket, coming in and making sure that the patient is warm and comfortable.

you know, before you're even having a conversation or a difficult conversation, body language, sitting, leaning against a wall, all of these things that say, have all the time in the world, even if you don't. And I think that sometimes when you have the idea that there could be a piece of technology out there that could allow us to provide the type of care

that we would like to be able to do. That really speaks to retention. So for any of the administrators out there that are listening to this and saying, shit, how does this apply to me? What I would say about that is that this absolutely applies because this is a retention tool. This is a patient satisfaction tool. This is all of those things.

And that's money right there. Okay? You know that that's a cost savings tool. And I'm not pitching this because I have any vested interest in this company. I feel really strongly that this is something that is so important to be able to provide better quality care. So I'm just going to like say that right now.

especially as I'm waiting for Dr. Zachariah to join the call again. Because I think he got like kicked off. But I was like, well, I'm going to finish my thought as he rejoins the call. because speaking of technology, that's just how we roll around here. So I'm going to actually message him and tell him just to jump back on.

Cara Lunsford (18:43.139)
It's also the beauty of editing because that's why we have my incredible wife, Dawn Lunsford, who is going to basically splice it back in. It's going to seem like he never went anywhere.

Cara Lunsford (19:40.481)
Hi, and you're back.

Finly (19:41.227)
So.

Cara Lunsford (19:46.509)
Can you hear me okay?

Finly (19:48.349)
I can. Yeah. Yeah. You're talking about the power of a warm blanket. And then I lost you. It's like, so good.

Cara Lunsford (19:55.159)
Yeah. No, no, it's okay. Actually. So here's the thing you dropped off, but I just continued. I continued talking and I was, I was talking about how important it is that we, the reason why this is important, like when, when an administrator or someone who is in an administrative position is thinking to themselves, how, does this? Yes.

Patient satisfaction, obviously that's an obvious one, right? That's just patient satisfaction, family satisfaction. That's obvious, right? But I would say that this is a retention tool because here's the other thing. How much money are they losing in turnover, right? Attrition, all of that. So much money, okay? You lose a nurse, you lose a doctor. This is millions.

millions and millions of dollars. Okay. And one of the key reasons that people leave is because they feel like they cannot provide safe care, the type of care they signed up to give. They feel it does not feel fulfilling to care for people in a meaningful way. And if you had a tool that could be kind of predictive, it could also help

you understand what it is that you're, what's important to your patients, helping you to advocate for them.

That is such an important thing because we pour through data, we try to spend time, we try, we do the best we can. Even if the patients are like, well, your best is not good enough, okay? But the thing is, is that I think most people do. Most people are doing the best they can. But this is where technology can really, really help us. And that's the kind of thing that I think is so unique.

Cara Lunsford (21:59.275)
and so cool about what Empower Hope is doing is because it doesn't just empower hope for the patient, it empowers hope for all of healthcare. Clinicians, physicians, patients, and administrators who I am certain want to have better outcomes.

Finly (22:18.859)
Absolutely. Yeah, just to build off of that for a couple of the different points. So for the staff, know, as even if we have a great tool or we have, you know, some questionnaire or something else that captures patient preferences, part of the challenge is that you don't know when to necessarily apply those preferences. And so there's specific preferences that are, you know, like the key event may be very relevant during the chemotherapy cycle or something else.

Whereas the preference to be at home at the end of life is going to clearly be the very late stage thing. And so now when you think about clinicians who have hundreds or thousands of patients who are there taking care of, it becomes almost impossible for them to remember everything about each patient and what's important. And software technology then helps to, you know, essentially codify that and capture it and then surface it to the clinicians when it's relevant. On the staff side of things, I have heard this so much from my nursing colleagues.

And just thinking about all the times I've been in the ICU and especially that being such an acute place of turnover and difficulty to have staff retention. Part of what I see oftentimes is the compassion fatigue that the nurses have and other staff have. And part of that, I feel like at least part of my supposition is that it's they spend so much more time with patients than I ever do as a physician.

And they get to know these patients and they also see a lot more about what's actually happening day to day and physiologically sometimes as well too, where we get these kind of more macro snapshots. And as they see sometimes, you know, this patient is actually not doing well. They are, you know, having a decline and then having, you know, effectively physicians or others kind of overwrite what they feel like is

We need to be having those like our conversations. need to be understanding that this person is there may need to be a shift in trajectory and not being able to exercise their voice or advocate effectively for the patients. I think also leads to that compassion, fatigue and moral distress that staff oftentimes feel. And so this this with empower hope, we feel like it's also a tool for that as well. To be able to say, how can you actually harm yourself with additional tools?

Finly (24:41.823)
the strongest voices and should be the patient's voice, right? And so if we don't even know that they have comfort or any preferences, it becomes challenging to even advocate for that or it becomes, well, that's your opinion versus, you know, my opinion and I'm the doctor and therefore, you know, this should, should go forward versus if it's yes, there's, you know, staff opinion, doctor opinion, but actually patient opinion in some ways, the doctor's opinion is actually secondary to the patient opinion as well. And it's then, okay, well, what

what's most best serving again, I think everyone is altruistic and wanting to do the best possible, but I think sometimes in that moment, we lose the sight of whose perspective is most important. And when we don't have that information from the patient ahead of time, it becomes very difficult to also apply it in those situations. But very much, yeah, see it as an empowerment tool to the staff as well as to patients. And we can get into also even the ROI piece.

Cara Lunsford (25:29.624)
Yeah.

Finly (25:37.917)
as well, but just from a self -respective view.

Cara Lunsford (25:38.647)
Yeah, yeah, we're definitely gonna touch on that because I think that that, you know, I hate to say it because sometimes I get a little, I don't know. I don't even know how to say it. I know that our healthcare system, it's a business. It just is, it's just the way we're built here. And you can agree with it, you can disagree with it, you can find.

It benefits around that. can find deficits around that. We could probably, to not get too woo -woo, the Libra in me wants to balance the scales on it. And I tend to see both sides, right? But it is important to understand the cost savings of something, because

Hopefully, and maybe this is the optimist in me, is that I want to believe that those cost savings will go back into the hospital in a meaningful way. That those will be used to, again, help with retention, find other tools that will improve patient outcomes, invest in other tools, invest in...

making sure that there's enough equipment for all the patients. I recently had to admit a family member, he had a stroke just last week and immediately saw that he had left side hemiparesis and slurred speech.

and had to call 911 and eventually we, you know, and we had to have him admitted for observation. The thing is, is that there was something that was really important to him, which was like also affecting his ability to be comfortable in the hospital because he really did not feel that his care team understood that my wife's birthday was coming up.

Cara Lunsford (28:04.469)
and he did not want to be in the hospital for her birthday. Now, obviously, if he had to be, that would make sense. Like if he just clinically was not stable enough to be able to come home, that that is understandable. He would have to be there. But if there was a way for him to be able to communicate his preferences or

help his care team to understand that he had this very important event coming up. It was very important to him. And maybe there were things that they could have done, or they could have expedited something, or they could have made sure that he was out of the hospital or stable enough to be out of the hospital if it was possible. And that's just like something, like that's an example that I'm thinking of.

that just comes to mind that's kind of relevant, I feel like to this conversation. How do you feel about that?

Finly (29:07.755)
Absolutely. Yeah, it's it's again, it's it's his preferences and and you know, how does the health care team even know that and I'm sure that you guys had shared that with the health care team but had Kennedy easier, right? And it's like, who are you sharing it to do you have to share it like 50 times or 100 times versus if you actually put it into a platform or patient portal to say,

Hey, this is what's really, really important to me. I want to be home, you know, for your wife's birthday and to be able to be there and be with family and to be present as much as possible. And then to be able to just show that once rather than trying to say, I think this person has carried it, you know, again, like they're, I don't think anyone is ill meaning when they capture these patient preferences from the family and then they have 20 other things or another patient has a very acute event and then.

you know, what was top of mind now becomes, you know, fifth on the list, and then they have the end of shift and now it may not have been communicated. It really is a way to say how do we again, put this front and center for the care team, and then have almost consistent handoffs effectively of patient preferences. So it's, it's there and present at all times.

Cara Lunsford (30:26.797)
Can you tell us a little bit about how, I'm thinking about this and I'm imagining if I was a nurse listening or if I'm a physician listening and I have my EHR pulled up, I'm looking at the patient's chart or how is it that I actually get notified? Like, where does this appear for me? So that it is, like you said, front and center.

when I'm giving report, is that something that comes up that's available for me so that when I'm giving report, it's something that is again front and center so I can say, by the way, patient preferences are this.

Finly (31:11.017)
Yeah, absolutely. Yeah, I think there's a couple different ways and so maybe putting my informatics hat on for a second here. Part of it is the passive and active ways to make sure staff are aware. So everyone loves alerts and things that break their workflows. Just kidding. So it's how do you actually put things meaningfully in a way that is highly visible and then is almost effectively passive

information. So I do see the relevance of like a specific tab. If you want to go and you want to see who this person is, being able to capture that information on the specific tab is one way to do it. But there are other ways where we've done stuff within some HRs where it's you can essentially create columns that allow for visibility of status so that it becomes part of the inpatient list or the outpatient list. And you can see what

what is kind of the status of specific things like goals of care conversations, for example, and has this person who is high risk or not actually had a goals of care conversation where you can then see, nope, this patient is high risk for specific conditions by AI model or by other clinical criteria, but they haven't even had a single goals of care conversation. That's not a kosher. We need to make sure that this happens.

And then there's, there's other times where again, you know, kind of speaking to towards end of life as an example, if you have now say, patient who's in the hospital and they have a more acute alert on this patient has a very short time to financially live. then that can actually create an interruptive alert to the clinical team. So kind of through a combination of, know, almost a repository within the HR where anyone can go to at their leisure.

having passive elements where it's, it's visible within the workflow. So people are able to see it for all patients. then thinking about very specific critical aspects and moments and preferences that need to be alerted at key times, then having interruptive alerts very, selectively for that. think one other thing I'll say too, and you know, with AI, there's, there's oftentimes a worry that, okay, you know, AI is going to take away my job. I'm going to, you know, it's going to

Finly (33:32.595)
Basically tell me what to do. And it's like, I went through how many years of school to actually get through this. Like what is it? What does AI do? And so I will say a strong premise of Empower Hope. And what I believe is that AI really should be there to augment clinician decision making, not replace it. And so, you know, there's also what is the validity of the tool that you're using and how good is it effectively?

And so with, with any of these things, there's always going to be trade -offs. If there's a perfect AI tool, amazing. I haven't seen it yet. but, when it's short of perfect, it's then more a series of trade -offs. And so is it, are you trying to go for high, what we call positive predictive value where you want to have it be right a lot of the time versus.

Am I okay with it being right less often, maybe 40 % of the time as we've seen in some studies where they'll say we want to capture the most patients and we don't want to miss anyone. So depending on how you set those tools, that's where it's again really important for the clinician at the front lines to understand not only what is this tool that I'm using, how is it actually configured for this specific application? And then giving them the ownership to say,

Again, this is meant to help you if you think this is bogus. That's that's fine. You shouldn't act on something that you don't believe in. But if it's a nudge and it helps you with this information when with transparency to help you, you know, both think of it as well as maybe confirm, you know, reasoning that you've had already, then you can further act on it and it becomes a secondary reinforcement.

Cara Lunsford (35:18.967)
Yeah, yeah. We did a, I did an interview with the, an executive from Microsoft and she is also a nurse. And in terms of patient experience and the things that she's doing to move the needle, also another person that I should probably put you in touch with.

I love connecting people. But we talked about AI and it was really interesting because we posted it on social and the nurses just, I mean, ripped it apart. I mean, just not, they didn't rip apart the episode. I mean, it was just a little snapshot. It was like one sentence that we released, a little teaser.

of the episode and boy, did it ignite a conversation on social. We realized that people had very strong feelings and they were like, I think making some assumptions that AI somehow was gonna replace them or that there's no replacement for human to human interaction. And I agree with that.

There is no replacement for human to human interaction. But to what you're saying is that what if technology improves our human to human interaction? It prompts us. It gives us better information. I would accept that all day long because I am limited. I'm limited to the amount of information I know. I'm limited to time.

how much time I have to go through somebody's chart. If AI could help me as a clinician to A, allow me to walk in the room and have a pretty good understanding of someone's past medical history and why they're in the hospital. And even some of like psychosocial stuff and socioeconomic stuff. If I had a pretty solid understanding of

Cara Lunsford (37:42.147)
who I'm walking in and talking to, who wouldn't want that? Who would not want that ability and have it be pretty accurate, right? And because right now I feel like we've got nowhere to go but up because I saw the type of care that my family member received in the hospital and this is not...

to trash the hospital system, or the hospital itself, or the people there, I was astonished. I hadn't really had someone who I cared about in the hospital for a while. hadn't really, I'd interviewed people, I'd talked to people, but I hadn't had a personal experience in a while. I even had a chance to talk to two nursing students who came in and offered,

my family member a warm blanket which was so sweet I asked them what when are you graduating they said October and I was like wow October I'm like what when you come here what are you what are you doing like what kind of clinical stuff are you doing what are you able to do we're only allowed to pass oral meds and give injection

I was like, what? And they said, I said, you're graduating in October.

Cara Lunsford (39:16.195)
I was dumbfounded. When I graduated 17 years ago, I graduated from county and a county nurse would hand me six charts, physical charts, and walk away until three o 'clock. And I had to do everything, all the patient care, every single thing for those patients. And that was county, okay? So you can just picture it. So.

Where we've gotten to, the people that are graduating, the lack of knowledge that they're going to have, the lack of information, they need technology to help prompt them. They're going to need to have that because otherwise it's not going to be safe.

Finly (40:03.611)
Absolutely. Yeah. And if there's somebody who's it's so I will say this is I see as a macro layer kind of on top of good medicine. Right. And it's like, if there's any question about skills development, or if there's limited amount of time, it shouldn't be kind of working on, you know, maybe quote fluffy stuff. It's actually making sure that you can take excellent care of the patient.

And then beyond that, and so just highlights the need all the more for how do we help make sure that, you know, if there's limited time spent on additional skills building or making sure that the appropriate things are happening and they're worried about those situations, et cetera, all of which is critically important and not necessarily subconscious because of the years of experience that nurses have. Then it's how do you again, yeah, make sure we can bring the right information relevant.

And really just more like we hear of so many amazing moments in the hospital of so many compassionate things that staff do or otherwise, but it's oftentimes a one off. And it's like, how do you almost say there's a book of like, hospitals should fly? And how do you standardize even just person centered care throughout healthcare systems and through, you know, with, what insurance companies can do and otherwise to make sure that this is just the

stable experience. This is part of the standard of care.

Cara Lunsford (41:27.629)
Yep. Yeah, absolutely. I know I got a little bit on my soapbox here, but I get really passionate about this stuff. Like this is like, this is, we have to adopt stuff like this. We have to. It's not a matter of like the, the, the should we, can we, no, it's like you, we are going to have to do this because there, there's, there are huge deficits.

in skills and things like that, that has to be addressed on its own. Those things have to be addressed, making sure that people are fully prepared to enter the workforce, that they have the skills. Because the thing is that people also leave, retention is definitely tied to a lack of feeling competent.

There's only so long that you feel like you can just roll the dice on people's lives, right? Every day kind of going, I don't really feel like I'm capable of doing this. I don't think I have the skill sets. I don't think I was prepared for this.

So that has to be addressed on its own as well. But I do feel like there are pieces of technology, there are things that could be brought in and to supplement, to help, to prompt. So that at least if you don't feel comfortable as a nurse or even like as an early resident or something like that where you're like,

I don't want to go to the attending and ask this question. Like I, or, or a new nurse not wanting to go to a more senior nurse, or there's not a senior nurse really on your floor who had, because we've seen that too, where like the most senior nurse has two years of experience on an entire floor. And so you have to have these types of tools and, and

Cara Lunsford (43:39.703)
things available. We have to.

Finly (43:44.299)
Absolutely. Yeah, totally, totally agree with that.

Cara Lunsford (43:48.087)
Yeah. And I know people are probably like, Kara must be like, you know, have stock in this company. She's like, I don't, I swear it out. I don't have stock in this company. But the thing is, is that as I've talked to you over time, and as I've talked to your business partner, I see the value. I really do see the value. there's other companies out there that are approaching.

things from an AI perspective in a different way that are also really important that we look at as a health system and as a healthcare industry. How do we keep things safe for people while we start addressing some of our core problems, some of the core problems that we have? We gotta have some things in place that help kind of bridge the gap or keep things safe.

or safer.

Finly (44:49.739)
Yeah, absolutely. Yeah, one of the things I wanted to kind of just reflect on was thinking about the role of the nurse and how do they help with kind of this whole spectrum. And so, one, I have the greatest appreciation and love for nurses. My wife is a nurse, my mom is a nurse. And so I would not be here in medicine without them and their influence on my life and my career.

one of the things that, that, and, know, I'm working very closely with nurses and the health system now too, where, they really have such a opportunity and, and that ability to have that voice. And so, yes, there, there can be concerns about, you know, should I raise certain things? but I think part of it is they may not realize how powerful they are in terms of the position that they have and the opportunity that they have. There's a million things on their plate, but.

you know, if they're able to capture them and stop and or if they're able to trigger it with the help of tools, you know, so take take something that's not necessarily directly empower hope that we can help with it is social determinants of health. And so, you know, social determinants of health, while there's a significant amount of growing evidence that shows that these needs are really impacting health and maybe 30 % of

of what's actually happening with the health of patients in the population, health systems aren't really designed to necessarily address social determinants of health needs. And so, yes, we want to capture and understand who the person is, but we actually would much rather try and refer into community -based health organizations and make sure that that's addressed. And so, if there's tools, which there's some great tools out there that help to screen and then help to connect

patients based off of need to community -based organizations. My suspicion is that most nurses and doctors and otherwise, they sometimes dive into these things because there is a lack of technology and a lack of solutions. But if it was, your patient has actually expressed that they have housing insecurity, food insecurity, there may be some issues at home that need to be addressed. By the way, the patient is actually consented to their information being shared.

Finly (47:06.003)
And it's already been routed to the appropriate community based organizations. And the next time you check in, you know, week, two weeks, et cetera, you'll be able to see what happened with those referrals. I think most staff would love that and wouldn't feel the need to, you know, jump in and help additionally, because it's like amazing. Our hospital has created and leveraged a technology that has supported the reinforcement of amazing exceptional care.

And that's kind of how we see some of the tools that Empower HOPE has where it's, you know, with say, advanced care planning or with, you know, understanding who they are in medical decision maker choices that might actually be a great conversation for the nurses to have the goals of care conversation of sharing prognosis specifically is more of a physician responsibility. And they need to have that. But once that's done, then the nurses also have

the ability and the opportunity to actually say, well, look, we've gone to a centralized place where all of these notes are, I see you have these conversations with your doctor. Let's talk about that. Let's explore that more. And you're able to then actually help evolve the patient's thinking and help refine it to be more clear in those choices. And then being able to share that back with the clinical team to say, look, this is coming from the patient.

you know, not necessarily my voice, it's actually, I'm just trying to amplify the patient's voice to you. It also frames it quite a bit differently for advocating for the patient and what they need from a person's other perspective. But just very, very highly appreciative of, you know, the role and opportunity that nurses have to be able to impact this whole spectrum.

Cara Lunsford (48:51.159)
Yeah, and I love that your wife and your mom are both nurses. Well, it speaks volumes also to your very holistic view of patient care. And I'm sure that you've heard stories and I'm sure that your wife shares with you the struggles that...

that we have, you know, spending 12 hours with a patient. There are definitely situations where, you know, I worked in pediatric oncology for many years, so I had a chance to really get to know my patients for long periods of time. They're families. I everyone comes out of the woodwork, right, when there's a child who has cancer, there's church people, there's family, there's everyone.

And you really get an opportunity to learn a lot about families. But the thing is, is that that takes time, right? It takes time to build those relationships, to have those conversations. And there's only so much that you have available to you in terms of time, right? But the thing is, that then there's different areas, right? There's emergency medicine. Well,

Those, they're just trying to make sure you stay alive long enough to either get discharged or to be moved to the floor. But it doesn't mean that they still shouldn't be, if they could be, armed with some more information about a patient, because they really don't have the time. They really have like very little time to get into those nuanced

conversations and to really understand patient preferences and things like that. But it is, I would say, even more important because they don't have enough time. So do you feel like, is there one area that you feel like you've gotten more traction in or more interest in, whether it's, you know, certain areas of

Cara Lunsford (51:11.233)
of the hospital or of medicine.

Finly (51:16.107)
Yeah, I think so one we're incredibly early, you know, and so I think there's there's a vision of like where we want to be and we want to be everywhere, you know, but the early days I think are really in that kind of end of life space. And again, knowing the massive disconnect that's happening right now, every day with you know, like for cancer, for example, two million patients are going to be diagnosed this year, 600 ,000 patients are going to die and have those 600 ,000. How many of them are going to actually have their preferences on their

Cara Lunsford (51:21.783)
Yes.

Finly (51:45.501)
I'm in a way that's meaningful versus just going through kind of the hamster wheel on the sense of the health care system. And so we do see opportunities from that standpoint. I would say both in the hospital as well as even like, et cetera, is, is, think, a key opportunity. We're trying to figure out right now, honestly, how to best work with different members of the team, if you would. And so it's, it's not just a holistic person approach, but it really is.

what we see as a challenge, which we're trying to overcome is there's so many different players in the space. There's, the post -secret agencies who are then working with the hospitals, who are then working with the insurance companies, the doctors are sometimes different medical groups, et cetera. And so it really takes all of them, you know, to be able to have a SEMA solution and focusing on some of those more critical points. Like, so with the ER, for example,

some of what we're trying to enable is essentially, can you actually have alerts to those healthcare systems, this patient's already on hospice as an example. And so the normal default is we're to go ahead and stabilize this patient, admit them, etc. You know, but if they actually knew this patient's actually with this hospice, this is their contact information. And you're able to then potentially stabilize the patient, but then get them back on to

hospice, if that was their preference, you can avoid a lot of suffering and also, you know, your point, save a lot of cost to the healthcare system. There's other, not necessarily ours yet, but we've heard of others in the space who are working with ERs to have AI tools that will identify patients and say, this patient may very well be appropriate for hospice. So why admit them, you potentially go through all sorts of series of tests and otherwise,

if you can actually have that conversation in the moment, the ER, and even transition them from the ER to home. Again, if it's patient aligned and appropriate, and you then have very close tight knit partnerships. But the yeah.

Cara Lunsford (53:56.263)
How amazing would that be? How amazing would that be is if someone could, you know, that we could save those beds in the hospital for admitting patients that truly do need to be admitted and actually intervene at appropriate times and bring in people like social workers and...

Finly (53:59.488)
Mm -hmm.

Cara Lunsford (54:20.321)
you know, end of life specialists and people to have those conversations with patients who might be scared and might be thinking that they do want to, you know, go into the hospital. But at the end of the day, if you're if you're able to sit down with them in that moment and say, look, here's the thing. Sure, we can admit you for a couple of days. And chances are you might end up dying here in the hospital. And

If that's what you want, if you're okay with that, we can absolutely make you comfortable, get you to the right place. But if you truly do want to be at home and you want to be in your own bed and you want to be with your family all around you and not be restricted to how many visitors can be in the room and if they can spend the night with you or if they can't or

that's something that you have to be able to intervene at that moment and really give people that, empower them, empower them to make the decision that makes sense for them. And so I think that that's just a perfect example of why this is so important. I just, I don't know if there's anything else that you would like to say. Is there anything else you,

feel like you didn't have a chance to talk about it that you want to say because I really want to make sure that you have an opportunity to say everything you want to say about why this is important to you.

Finly (56:01.663)
Maybe maybe one last element is even as many players as as there are in the space. There's also a lot of work that our healthcare system has to do overall and just how we apply. You know, even even just the insurance plans, you know, and so one of the things that that's a parallel soapbox of mine within the space is.

You know, we have hospice, which is a very defined benefit. It's amazing. There's also home -based palliative care, and that's a emerging opportunity for post -acute agencies to move into a space where they're able to partner with healthcare systems and work with patients with serious illness. But the challenge is that it's not well -defined in terms of how inter -entry inverses for it. And even if you have one of the large insurers,

There's so many managed plans underneath it that candidly as a inline clinician, I have no idea even if the macro and transplant says, yep, we cover palliative care for patients. I don't know if this patient in front of me actually has palliative care covered. And as you know from the pediatric oncology space, there's so much literature showing that patients who are even able to actually for concurrent care, for example, beyond hospice,

There's massive benefits to the family, massive benefits to the healthcare system and insurance companies overall from ROI. That same benefit is there with home -based palliative care. And I think we need to work just as hard on the policies and making sure that when people are saying we provide palliative care, that they're as transparent as possible about it. If it's you provide palliative care, please then do that across the board. Make it a core part of all your managed

plans, not just have it be that we offer it. And by the way, it's for the 1 % of plans that are just our main plan and not the ones that are that are outsourced. there's technology, basically, my point is more that technology can only help so much. It's not going to, as you said, replace that human to human connection, and that we want to amplify. It's also not going to replace elements that are unrefined or broken in our healthcare system.

Finly (58:25.213)
And so we need just as much work on those pieces as well, even while we're trying to bring technology, which will certainly help with a portion of this.

Cara Lunsford (58:34.337)
Yeah, you're absolutely right. mean, like you, you don't want it to, you don't want a piece of technology that prompts you to do certain things. And then you realize that there's, there's not even that the solution doesn't exist or it doesn't exist for that patient. Like that, that's also very demoralizing for the clinician, for the patient to say, well, this is the recommended route. However, that's not available to you. So

that, I mean, that's just, that's just has to be fixed as well. All those things have to be in place. So I think that was such a great call out is that, yeah, there is only so much that we can do if there's not systems and, and programs in place and paid for by insurance that can allow you to actually have

the very experience that Empower Hope is hoping to be able to provide to patients. So that was such a great call out and such a wonderful interview. Thank you for also allowing me to get on my soapbox every once in a while. try to, for the most part, allow the interviewee to speak a lot, but every once in a while I get really passionate and I run with things.

This was really such an enjoyable conversation.

Finly (01:00:02.955)
Thank you for the time, I really appreciate it.

Cara Lunsford (01:00:05.803)
Yeah, absolutely. All right, well, we will catch up and I will also be making some of those connections for you because I think that they could really help move the needle. thanks so much for spending an hour with me, Dr. Zachariah.

Finly (01:00:22.091)
Thank you so much.

Cara Lunsford (01:00:24.299)
All right, talk to you soon. Bye.

Finly (01:00:26.367)
Very good. Bye.