Insiders Scoop: Rectifying Systemic Deficiencies with Digital Health – Dr. Geeta Nayyar


Geeta Nayyar


Name: Geeta Nayyar, MD, MBA

Specialty/Interests: Rheumatology | Health Technology

Education: University of Miami (BS) (MD) | George Washington University (MBA)

Current Position: Chief Medical Officer at Salesforce | Associate Professor at the University of Miami School of Medicine | Medical Contributor at CNN

About Dr. Nayyar:

Dr. Nayyar is the Chief Medical Officer at Salesforce and an Associate Professor of Medicine at the University of Miami specializing in Rheumatology. Asa regular medical contributor to CNN and PBS, she is a nationally recognized healthcare leader and currently serves on the board for the American Telemedicine Association and the University of Miami Medical School Alumni Board. Leveraging a unique perspective bridging clinical medicine, business, and digital health, she is focused on bringing to fruition the digital transformation of healthcare, accelerated by the pandemic. Recognizing the need for systemic reform, Dr. Nayyar is currently focused on harnessing telemedicine, remote patient monitoring, and a host of digital health technologies to extend the four walls of the hospital, facilitate a deeper connection between patients and doctors, and redress the infrastructural challenges facing healthcare today.


1 | Alongside your role as a practicing Rheumatologist, what are you working on in the health-technology sector?

I am the Chief Medical Officer of Salesforce, and the digital transformation of healthcare is what I’m passionate about. This transformation has been accelerated by the pandemic, and we’re currently focused on leveraging telemedicine, remote patient monitoring, and a host of digital health technologies to extend the four walls of the hospital and facilitate a richer connection between patients and doctors, which ultimately translates to improved health outcomes and provides a tangible opportunity for systemic reform.

We’ve seen the disconnects and the broken components of the healthcare system come to light during the pandemic. Just as we have to invest in our infrastructure after a war to ensure that we are prepared for future predicaments, we have a responsibility to address our healthcare infrastructure today. The crisis we’re facing is still not over, and we can leverage digital tools to address systemic deficiencies.


2 | What is it about health technology that most excites you today?

The challenges that we’ve navigated throughout this pandemic have made the future of technology and its vital importance very clear. We’ve been in a lockdown, out of lockdown, we’ve been burnt out, we’ve had capacity issues, and we’ve had to circumvent a cascade of underlying challenges and a great deal of friction in all aspects of our healthcare system.

That said, I think the pandemic has demonstrated that there is a real and tangible need to finetune our healthcare system, and I believe that if we can build the correct technology, implement it appropriately, and refine its integration alongside cultural processes and reimbursement processes, alongside a host of other intricacies, we can eventually create an extended patient care experience outside of the four walls of the hospital.

Whether that’s through virtual medicine, texts, calls, pamphlets, telemedicine – and just to be clear, many of us think about telemedicine as a virtual visit, but telemedicine is really anything that extends beyond those four walls and that ten-minute conversation – we have so many avenues that we can capitalize on.


3 | On a technical level, where do you see technology being implemented in the treatment process?

When it comes to the treatment process, there are three stages: the pre-visit, the appointment itself, and the post-visit. There are so many things a patient has to do in the previsit stage to just ensure that an appointment is set, then there’s the actual delivery of care, and a few subsequent steps in the post-visit phase. The exciting thing is that technology offers us an opportunity at each of these three touchpoints, and we can really transform care for the better if we leverage these digital opportunities correctly.

I will note that technology does not necessarily help physicians, and that’s clear when we simply look at the Electronic Health Records (EHRs) that have contributed to burnout. This situation and the resulting epidemic of physician burnout being combatted nationally provides a valuable lesson: technology needs to be integrated cautiously, and its integration needs to be done with physicians.

The technological revolution in healthcare needs to be done with physicians and not to physicians. It needs to be created alongside physicians early in the product development process and their insights need to be harnessed in the implementation stages to ensure that all systems align in a manner that workflow and cultural processes aren’t compromised.

That said, I think the important thing is, and what excites me most, is that we are seeing an opportunity to leverage technology, refine and implement more sophisticated forms in healthcare, and there is no doubt in my mind that a tech boom is going to happen in healthcare because that is the only way to improve the system.


4 | How did you navigate your transition partly out of clinical practice and into the business sector as a medical executive?

I’m a firm believer that you have to follow your passion. Your career will blossom, financial rewards will be reaped, and a whole basket of rewards will follow if you follow your passion.

Personally, I have always been a very passionate clinician – I know I will never stop seeing patients, and I actually hope that in my retirement, I can see more patients and do more teaching because that is all in line with what excites me. There are different strokes for different folks, and there are many reasons why many of us go into medicine. I would hope that the underlying drive for most people who pursue medicine is to provide care for patients, but everyone’s passion varies, and when passion is considered alongside the realities of life, people will be led in different directions.

Some may wish to take on a full-time administrative role, an executive role, or will dedicate a great deal of time towards their family. There is always a lot to balance, but I fundamentally believe that everyone must find and follow their passion, protect that interest with all their might, and for me, it was important that I keep practicing clinical medicine alongside my work in health technology and business.


5 | What were some hindrances you shouldered through when transitioning from clinical practice into the healthcare technology sphere?

First of all, we aren’t trained for any type of career transition – we are trained to become practicing doctors. I had no business skills and had never previously worked in a business environment. While I did pursue an MBA, my training as a doctor was substantially different from what was needed in the business world.

My training instilled within me a practice of writing in shorthand because in a clinical setting, your notes are meant to be inputted in an efficient, concise manner. However, this usage of abbreviated and concise notation does not translate well in corporate America. If you were to send an email without proper grammar and proper spelling, or if you utilized some of the shorthand notation we use in a clinical setting, your emails will be received in various ways.

To name a tangible example, my clinical training taught me to type “F-U” after my documents, translating to “follow up” for other clinicians. While this works efficiently and effectively in a clinical setting, when people receive emails saying “F-U Later” in a corporate setting, they don’t understand the context.

There’s a level of friction that has to be overcome due to differences in training, and it takes time to fully acclimate into the non-clinical world. While some of these things may appear to be small mistakes, the reality is that ****communication is fundamentally different in medicine and business, and as a consequence, any career transition comes with a steep learning curve and takes substantial time to navigate.


6 | What would you like to say to physicians interested in partly stepping out of clinical practice to get involved in systems-level work in healthcare?

I want to preface my advice by saying that this transition truly scared me. I took a risk and bet on myself, and I found comfort in the fact that if things didn’t work out, I would fall back into my role as a provider.

I think this is a key piece of advice that people should keep in mind when evaluating whether or not they should make a career transition. As academics, we want everything to be a science, and we want our decision-making to be founded on clarity and understanding acquired by experience. However, that is not how the business world works. The business world is less academic and more creative, and one has to be willing to embrace risk and bet on his or her self.

Sure, you should pursue these new avenues in a manner where you have a backup career available as a care provider, which is never a bad thing. Many non-clinicians make huge leaps and transitions without having any such option to fall back on, so I think any of us who are considering pursuing something nontraditional should recognize that we have a great insurance plan to fall back on. With the job security that we have in medicine, people shouldn’t be afraid to think big and pursue their dreams.


7 | If you were to distill the major infrastructural problems facing healthcare down to a few key challenges, what issues most immediately come to mind?

The infrastructural challenges facing healthcare boil down to three primary elements: culture, processes, and people. Any effort to redress our institutional challenges will leave one questioning how we can change culture, how we can change processes, and how we can change people.

It comes down to systemic issues in the industry and our ability to put the patient experience first. By focusing on the patient experience, you are inevitably putting the clinician experience right up there with equivalent importance because to ensure that your patients are happy and receiving high-quality care, you need to ensure that your clinicians are also engaged happily in their work.

Protecting our workforce, taking physician burnout really seriously, making sure reimbursements are appropriate – appropriate for licensure, appropriate for the site of service, appropriate for skill, clinical problem, and thinking – are all of major importance at the present moment.

As we think about this digital transformation and how we can rectify these problems by leveraging technology, there remains a lot for us to figure out. That said, many industries have done it, and we have a lot to learn from such industries. Fortunately, we have the technology, but we need a means of integrating it. We should remain optimistic and continue driving progress to ensure its effective implementation.


8 | What tangible changes will technology introduce into medicine within the next 10-100 years?

I think the holy grail of medicine is being able to deliver personalized medicine. If Jane Doe is a 3-year-old African American female, knowing she is a Lupus patient, then x might be the best medication for her. The studies to date can be limited to one population, one gender, or perhaps one ethnicity. Being able to leverage high volumes of data can overcome these limitations because we can use that information to make predictions and personalize care to the needs of the individual.

Right now when we see a diabetic patient, we will estimate and say we will see them again sometime between six weeks to three months. To actually predict when someone needs an intervention so they don’t end up in the emergency room or suffer from an adverse outcome is really the promise of newfound AI and data analytics.


9 | How might technology alter the dynamic between insurers, the government, patients, and providers?

I hope that the cultural processes we talked about move in the direction of happier patients and happier doctors. A lot of that has to do with reimbursement and what treatments are appropriate for patients.


10 | What would you like to share with burned-out physician readers currently vexed with technology in healthcare?

First and foremost, I know it has been a really tough year for physicians at the front line. The value of physicians has certainly gone up over this pandemic, and every physician out there should feel reinspired in their profession. As rough as it has been, we certainly need physicians now more than ever.

What I would say to them is that their voice matters more than they realize. Going to the hospital CIO, CTO, and vocalizing the things that are not working is very important.

The CIOs and the CTOs are all challenged by the fact that the engineering department doesn’t have access to enough physicians in their decision-making between products and their implementation. We need physicians to voice their thoughts and inform these staff members, and by getting involved, we can provide much-needed insight on how things should move forward to correct things. Physician leadership is needed more than ever in this tech disconnect and the lack of them is a great cause of this disconnect.


11 | What advice do you have for premed and medical students?

Medicine is hands down the best profession. I am a very proud, passionate doc. I feel so inspired working with medical students at the University of Miami. Every time I look at them, I feel like I’m reliving my medical education journey again and it is so inspiring. That said, there is so much work to be done.

As we learned through COVID-19, there is work on the frontlines and the backends. Wherever there is a place to add value, I would say there is a need for physicians fit for leadership, administration, and IT, but we fundamentally need them clinically. If students can find that balance, they’ll have a prosperous and thriving career where they can contribute to their community and society and also enjoy personal fulfillment.

I’m personally very glad to have taken the journey that I have and I encourage others. I have a 9-year-old – listen, if she did what I did that would be great but admittedly, I’m pretty sure she’s not interested in becoming a doctor. As always, that is okay because we just have to follow our passions.


12 | What disciplines should physicians-in-training immerse themselves within, given the problems facing the healthcare landscape?

I believe the answer to that question is contingent entirely upon passion. I’ve mentioned this before but I really want to emphasize that I fundamentally believe in following your passion. If there is a particular area or field of medicine of great interest to you, embrace that interest and throw yourself into that domain deeply.

If you are a great communicator, doing things around communications is great. If you love technology, get involved in the tech side of the hospital. Whatever it is that sets your soul on fire in medicine or that you’re exploring – go towards it.

You should explore these avenues even if it deviates from the traditional path. The more you follow your passion, the more you will find opportunities that will ultimately put you where you want. That could entail spending time in a certain department, doing research in a specific niche, or surrounding yourself with people that you want to be like in 10-20 years. Being around people who are interesting and have the same interests as you – following that inner voice and that inner spirit will guide you to get where you ultimately want to get.


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