Brain Health with Vituity Drs. Yafa Minazad and Arbi Ohanian

Technology for brain health seems like a no-brainer, right? In this episode, we chat with neurologists Drs. Yafa Minazad and Arbi Ohanian about the latest advancements in neuro-tech and what it means to their practice. Find out where the field of neuroscience might be headed next.

Make sure you like and subscribe to "For Startups, By Physicians" wherever you get your podcasts. And keep up with us on LinkedIn, Twitter, and Medium at @InflectHealth, and on the web at InflectHealth.com.

Transcript

[00:00:00] Lindsay Kriger: Hey everyone. This is Lindsay Kriger, director at Inflect Health, the innovation hub of Vituity, where we strive to be a catalyst for better care. I'm thrilled to be hosting "For Startups, by Physicians" where we share insights and guidance to healthcare startups and technologists looking to create the future of health.

[00:00:18] Lindsay Kriger: As a physician-founded firm, we have connections with clinicians and intimate knowledge of what they need and how. We will be interviewing our executives, frontline providers, and industry leaders to help your business be effective and scale. Thanks for joining and let's get going.

[00:00:43] Lindsay Kriger: Welcome everybody to For Startups by Physicians. I'm joined by two of my absolute favorite doctors to talk about brain health and neurology. Dr. Minzazad and Dr. Ohanian have been with Vituity for, [00:01:00] what, almost five years now. It's been a long time since we started this journey of introducing the neurology practice to Vituity and as we continue to innovate within our division, they are always at the cutting edge of what's new and exciting. So I'm happy to have them on the podcast. Arbi, why don't you go ahead and just introduce yourself briefly and then we can pass it over to Yafa. 

[00:01:24] Arbi Ohanian: Sure. Hi Lindsay. Thanks for having us. My name is Arbi Ohanian. I'm one of the vice presidents of neurology for Vituity. My subspecialty is in vascular neurology stroke. I did my training at UCLA, both residency as well as fellowship. And joined Vituity in 2017.

[00:01:43] Lindsay Kriger: Awesome. And Yafa, tell us a little bit about yourself. 

[00:01:46] Yafa Minazad: Hi, I'm Yafa Minazad. I'm a neurologist as well, and one of the VPs of neurology with Vituity. I trained in neurophysiology. I take care of patients with seizures and epilepsy and stroke as well, and do both in-patient and [00:02:00] outpatient care. 

[00:02:00] Lindsay Kriger: Thanks. All right, great.

[00:02:02] Lindsay Kriger: We're here to talk a little bit about how practitioners and physicians want to see technology built and how did it have technology enhance their practices. You all have been super early adopters of many different technologies. Telehealth programs have been part of your D N A for many years. Arbi maybe tell me one thing that you feel like has really transformed your clinical practice in the last few years.

[00:02:28] Arbi Ohanian: In general, I would say neurology has gone from a, how would you say, like a contemplative type of a field, more to a therapeutic or treatment type of field because of the developments that we've had in all the different aspects of neurology. What I do specifically in the stroke world, there's been a lot of developments as far as interventional devices go, imaging goes, a lot of therapeutics are being developed.

[00:02:52] Arbi Ohanian: And then of course, telehealth, which we all talk about, has helped provide all these treatments and therapies to patients, giving them access [00:03:00] essentially. 

[00:03:03] Lindsay Kriger: So if everyone can imagine 15 years ago, if you were having signs and symptoms of a stroke, you would go into the emergency department and hope someone knew how to take care of you. And now you walk into emergency department and you can have amazing well-trained physicians on the other end of a video within minutes. That's really impressive. 

[00:03:22] Lindsay Kriger: Yafa, I know that you have done so much also introducing a really quality care remotely and using technology in innovative ways. Tell us a little bit about some of the favorite things you've seen that have come out of the industry. 

[00:03:36] Yafa Minazad: One of the most interesting things is the advancement in technology and computer and remote access to EEG. So give you a quick example: up until maybe 15, 10, 15 years ago, the only way we could do EEG is you had to have an analog equipment at the patient bedside. You could only monitor the brain for about 20 minutes, and then you had to get off the monitoring, and then you had a paper EEG that you would [00:04:00] sit down and read. And the neurologist had to be present at the bedside to read them. So if somebody was in status or was having seizures, you couldn't be able to take care of the patient right away.

[00:04:08] Yafa Minazad: Now, with access to computers at EEG and to remote access, we can actually monitor, do EEGs continuously for hours and hours on these patients and monitor their brain just like you would do at EKG monitoring in the ICU continuously, so we can pick up brain injuries, we can pick up seizures. We could really help with brain health and outcome with the patients just by that, having that very smart technology advancement in computer for ag readings.

[00:04:37] Lindsay Kriger: Yeah, I think neurology's one of the areas, at least for me, in, in our realm that we work with, that you have a hard time even imagining how you guys practiced 15 years ago because of the advancements in technology. It's just really exciting. 

[00:04:49] Lindsay Kriger: So if we were to take ourselves 15 years into the future, what do you think that's going to look like? How much more can we advance? What are you excited about that technology might be able to [00:05:00] even create a greater opportunity for care delivery? 

[00:05:04] Arbi Ohanian: I think a couple things are gonna happen: One is our population is gonna change tremendously. We've been preparing for this aging population and it's happening.

[00:05:12] Arbi Ohanian: And neurology's probably gonna get you hit the most by this. As the population ages, you're gonna see a lot more vascular conditions. You're gonna see a lot more of the neurodegenerative conditions — Parkinson's, Alzheimer's, dementias, the different dementias. 

[00:05:24] Arbi Ohanian: And then the other thing that's really interesting, because we're developing all these different treatments that we didn't have previously. We're actually go going to have a new population of survivors. So we're gonna have a whole set of stroke survivors who are now left disabled, but survived, Parkinson's survivors who are now living longer into older age. And that's gonna bring a lot of new issues as far as rehabilitation goes, treatments go.

[00:05:50] Arbi Ohanian: So we're, I think the kind of things we're gonna see is virtual VR type of technology for rehab at home because it's gonna be hard to [00:06:00] provide that scale of rehabilitation for these patients. We're also gonna see, I think, a lot more directed patient care. So making sure that the patient sees this correct specialist as opposed to the current type of medicine where you go to your internist sends you to a general neurologist who then might send you to a specialist.

[00:06:17] Arbi Ohanian: I think ultimately through technologies we'll be able to better direct patients to the appropriate provider. 

[00:06:24] Lindsay Kriger: Yeah, and that'll be so helpful both from the consumer perspective. As well as the provider perspective. We talk a lot about consumers in healthcare being the patient, but one thing that we're really preaching at Inflect is making sure that we think about the doctors as the consumer like you both are.

[00:06:42] Lindsay Kriger: I know you both working crazy hours, crazy amount of demands. What you all go through to provide critical care is a lot. And I think that more technologists and more tech needs to think about the end user as the doctors, as well as what the patients are [00:07:00] expecting and the consumerization of this industry as well.

[00:07:02] Lindsay Kriger: So I, I think that point Arbi is well taken, that if we can get the right people to the right level of care, however that happens, and how technology can aid, obviously that'll make your life a lot easier too. And you'll be able to really practice that specialty that you've been trained to do.

[00:07:19] Lindsay Kriger: Yafa, what about you? What do think in 10 years you're gonna be doing differently than you do now? 

[00:07:23] Yafa Minazad: It, it's funny if you look at cardiologists and what cardiology has like achieved in the past 20, 30 years, they have been able to do all kinds of scenting, clot removal, all kinds of vascular events around the heart for many years, and they've advanced in their devices.

[00:07:40] Yafa Minazad: And the same thing goes with the pacemaker, with the electrical activity of their heart. They have had amazing advancement in technology in managing their heart, the electrical activity, pacemakers, arrhythmias, irregular heart rhythms and all that. Brain has always been a very difficult area to reach because of the risk of complications.

[00:07:57] Yafa Minazad: But I feel like right now we're at the [00:08:00] verge of exploding in technology that will help the help patients with brain health in various stages of stroke. We're gonna come up with more devices that do a faster, better job of taking a clot out of the brain with that event of a stroke, which is one of the most disabling and problematic diseases in this country.

[00:08:19] Yafa Minazad: And also with brain irregularity or arrhythmias or seizures you wanna call. There are tons of other advanced technology that is coming up. I can't wait to see, in 10 years, I'm sure we're gonna look back and see the amount of technology and the amount of advancement in the work that comes along with that, it achieves even more incredible cure or treatment for the patients.

[00:08:42] Yafa Minazad: It's going to be pretty exciting. 

[00:08:44] Lindsay Kriger: Yeah and to that end, the brain feels still to so many lay people as such a mysterious thing or mysterious place. What do you think technologists and startups and people that are really trying to disrupt this industry should know about brain health or [00:09:00] where do you see the most sort of opportunities specifically surrounding the brain and what we might know or might not know? 

[00:09:07] Arbi Ohanian: If I was a technology company, I was trying to prepare for this, the main thing would be to realize that neuroscientists know very little about the brain too. There's a lot of learning that we're doing. So you have to be nimble and be ready to quickly respond to any needs that arise. And I think you're gonna see a lot of needs arising. At any given time they say there's about 500 different neurotherapeutics that are being developed, and so that's very exciting. Previously, like I said, it was a contemplative field. There's no treatments now, there's tons of new treatments that we're not even considering that'll be available in 10 years. And just if you're a technology company and you position yourself correctly, I think there's a world of opportunities if you don't pigeonhole yourself into very specific parts of technology.

[00:09:50] Lindsay Kriger: Yeah. So Arbi, if you could have a technologist and a founder come into your office or your virtual office and build you from think tomorrow, what are the things that [00:10:00] you really feel like would make your practice that much better? 

[00:10:04] Arbi Ohanian: The biggest problem for my practice, my outpatient practice at least, maybe we can talk about that.

[00:10:08] Arbi Ohanian: My outpatient practice, wait times are three to six months. And I'm a stroke specialist. I like to focus on stroke and headache and certain conditions that I've kinda specialized over time, but my office is filled with neuropathies and patients that I'm not super specialized in. And so, that, that whole coordination has, is been done very poorly.

[00:10:30] Arbi Ohanian: So I think in 10 years or a technology company if they could figure out the formula there for providing that access to the right specialist, to the right patient with the third party payer supporting that, I think that's probably gonna be the single most beneficial thing that could happen for my practice.

[00:10:49] Lindsay Kriger: Yeah, and that brings up a interesting point, and we've talked about this on other podcasts, which is, there's these out there innovations and ideas and [00:11:00] technologies about virtual reality and all these things that feel far away from actual operations of your day-to-day practice. And we always wonder, why hasn't Amazon fixed this? Why hasn't Google fixed this? Like we all know in healthcare that there's so many operational day-to-day problems that these tech companies have figured out for many other industries, why can't they figure it out for healthcare? And that just makes me think like what you're saying, something that could create efficiency and operations to allow for more access, more quality. 

[00:11:30] Arbi Ohanian: I was saying in neurology there's major stagnant work population as well. There hasn't been much growth as far as the neurology workforce goes, which makes that an even more compounded problem. 

[00:11:40] Lindsay Kriger: Yafa, I was just wondering from your perspective, if the technologist came in and waved a magic wand and said, what can you fix today, maybe talk specifically about your, about the remote work that you do. What technology would you say I have to have this tomorrow to make my life better? 

[00:11:56] Yafa Minazad: Oh my God, there are so many of them. Having a [00:12:00] better access to the patients, even though telemedicine is wonderful and you put the camera in and you can get to see the patient.

[00:12:05] Yafa Minazad: But there's many other experiences with telemedicine that we can have that we can't have right now. For example, checking the sensory, doing the reflexes, even being able to do some certain kind of procedures that you could do robotically — for example, EMG nerve conduction study where you absolutely have to be present to do them.

[00:12:21] Yafa Minazad: There are robots right now that do surgery. Why wouldn't we be able to do a simple study at the patient's bedside if we could enhance and advance our technology? The fact that access to neurologist is going to be very difficult. We're gonna have to find ways to make it very easy for a neurologist to have access to the patients with a quick, rapid like moving of the one.

[00:12:43] Yafa Minazad: And to have a neurologist, drive, park the car, get in the hospital, see the patient, and then, Back, go to the next one, it's going to be absolutely impossible. We really reduce access. So I think having a much better telemedicine service with a better touch and we can get very creative about it is going to [00:13:00] revolutionize our care.

[00:13:02] Lindsay Kriger: Yeah. So I know you both practice inside the hospitals while some days are sitting at home doing telemedicine, some days to figure out doing operations and business development. What is something that you feel a healthcare company should be focused on in the hospital work or the out of the hospital work, or, where do you think the market is for disruption in the brain health space? 

[00:13:26] Arbi Ohanian: I think the market is gonna be getting rid of as many walls as you can. So we've talked about this previously offline. I'm not a big fan of neurology clinics and as much as possible outpatient physical centers, especially for neurology. The vast majority of what we do can be done virtually.

[00:13:46] Arbi Ohanian: One thing I've been doing in, in my outpatient practice that I'm actually trying out, so hopefully we can do this at Vituity at some point as well, is my stroke patients. I'm sending them monitoring device, which, they're, they do it at home. They monitor their blood pressure, they monitor their heart rate, [00:14:00] their their blood sugars, everything's monitored.

[00:14:01] Arbi Ohanian: And then I get a report. So I'm able to more exactly treat that patient. But also I don't need that patient to drive in every week and see me. I'm able to do a lot of that virtually and probably to do a better job with that. So I think if you can get rid of that brick and mortar as much as possible, I think that'd be the biggest option in the field.

[00:14:19] Arbi Ohanian: COVID, in a weird way, is going to be the driving force for this. If you look at take virtual visits pre-COVID, it was less than 10% of patients had ever done a virtual visit. After COVID, they're saying something around 40% have already done it, 70% we'll accept it. So I think it's an acceptable thing now, and it's an opportunity to cut major cost, allow for scalability. And then I'd probably provide better care actually for the patient and more convenient care, more consumer appreciated care. 

[00:14:49] Lindsay Kriger: I hope after this podcast you have 15 remote monitoring device companies coming after you for your business. That's great that you're already adopting. 

[00:14:57] Lindsay Kriger: Yafa, what do you think the outside of the [00:15:00] walls of the hospital, so to speak, or outside of the brick and mortar space can do for patients in the future? 

[00:15:05] Yafa Minazad: I think most of the care is gonna be pushed to the outpatient, so we have to be really smart and really direct and hone in our technology to the outpatient. The thing that I see missing from a lot of companies that I talk to, I get any, it's not frustrating, but it's interesting because what I see is that they have super brilliant people who can come up with an incredible technology to monitor certain things and to do it certain aspects and everything. But if they cannot connect it clinically to the patient and the patient need and to the actual day-to-day activity and the health and the doctor use.

[00:15:39] Yafa Minazad: So we see a lot of great technology out there, but I'm like, you know what? This is not going to be something time sensitive for me to use, so I'm not gonna use it even though it's fantastic, but, If the technology company actually engage doctors who are in practice, not the ones who are clinically scientific or develop technology, but the ones just like us, who are in the [00:16:00] office, in and out. We deal with the inpatient, we deal with the outpatient, we deal with the transition. If they interact with physicians like that — I get their input ahead of time — I think the technological devices or solutions that they come up with is going to make a lot more clinical sense that will be used.

[00:16:17] Yafa Minazad: Otherwise they're gonna need to have a lot of revisions until they get to where they need to get. 

[00:16:20] Lindsay Kriger: Absolutely. And that's why we have you both on, and that's why Inflect Health exists because we are trying to bring frontline providers to technology. So thank you for sharing that. I think it's a good transition.

[00:16:34] Lindsay Kriger: As we wrap up, anything else you guys wanna share about your practices and what would make you want to participate in more technology or have more technology in your practices, here's your time. Let everyone know. Anything to add?

[00:16:50] Yafa Minazad: I add one thing to what I just told you: we've had a challenge, many challenges with multiple electronic medical records. You would think we would have it down by now. When it comes to [00:17:00] EMR, we've had a, you have an outpatient electronic medical recorded inpatient. EMR and every once in a while we sit there and look at the equipment and say, did they actually talk to the physician or to a clinic, or to the patient or to the staff before they made this?

[00:17:15] Yafa Minazad: Because it's amazing, but it doesn't like dance with the show in the office. So I think my last, if I had to like, get some message across for all these companies is that talk to many doctors, talk to many specialists, understand what it is at at stake clinic. Quality of life, patient's life, day-to-day lives, what are they looking for? And try to really adjust and focus your effort into solving that problem. 

[00:17:39] Arbi Ohanian: Yafa brings up a really good point. I'll tell you one thing that I've seen happen in the telemedicine field. The initial devices that were made had these amazing, really cool gadgets and bells and whistles, but that we never use. We don't need and it's an extra expense for a hospital that made it cost prohibitive. So a lot of hospitals wouldn't do it. [00:18:00] And then they figured out that there was, what the physician actually needs is a lot less than all of that. And now a lot of hospitals are adopting it because it's not cost prohibitive.

[00:18:08] Arbi Ohanian: Had they spent a little more time probably up front on physician needs and true requirements, they probably could have solved that a little earlier on. 

[00:18:18] Lindsay Kriger: A little cheaper too. 

[00:18:19] Arbi Ohanian: Yeah, exactly. 

[00:18:20] Lindsay Kriger: Great. I am so glad you both came on. I know you are close friends and colleagues, excellent clinicians, and it's a real pleasure to have you on our team, of course. Thank you for being here and we look forward to seeing what innovations come about in the years to come. 

[00:18:36] Yafa Minazad: Thanks for having us. This has been really fun. 

[00:18:38] Arbi Ohanian: Thank you, Lindsay. 

[00:18:40] Lindsay Kriger: Thanks for joining us, and again, I'm Lindsay Kriger, director at Inflect Health here at inflect. The future of medicine care and health delivery is not just right for disruption.

[00:18:50] Lindsay Kriger: It's increasingly personalized, accessible, and human. Make sure you like and subscribe to "For Startups, by Physicians" wherever you get [00:19:00] your podcasts. And keep up with us on LinkedIn, Twitter, and Medium at Inflect Health, and on the web at inflecthealth.com.