Digital Twins Could Be a Game-Changer for Scalable Healthcare Innovation

Q: Hi Inder, it’s great to have you on the podcast. I am Rohit Mahajan. I’m the managing partner and CEO at BigRio and Damo Consulting. This Big Unlock podcast was actually started by Paddy Padmanabhan, who founded and started Damo Consulting. I’m very happy to carry on his legacy. He’s pretty well known in the healthcare circles. I’m sure you’ve probably met him at one of the conferences as well.

So, super excited to have you here Inder, and over to you for your introduction.

Inderpal: Thank you, Rohit. And yes, you bring up Paddy, and who doesn’t know him and what a great individual he was. I’m glad I had the opportunity to work with him. Thank you for this opportunity. I’ve been in healthcare technology space for over two decades now, consistently working on innovation and digital transformation across complex organizations. I have very good experience working with some of the best organizations in the area. I landed in healthcare at Columbia University Medical Center, had a long stint at HSS in New York, and then Englewood Health in New Jersey. I’ve gained experience by rising up the ladder over these years and have a good grasp of the entire continuum of healthcare from a provider and patient delivery perspective. I’m really excited to talk about what my experiences have been and what your viewers are interested in. 

Q: Absolutely. Inder, like you said, you got started in healthcare over 20 years ago, and you worked with some of the finest institutions. You are well regarded as a healthcare leader in the space. Tell us more: what attracted you or how did you gravitate into healthcare? 

Inderpal: The first few years of my career, I worked in India, Southeast Asia, and the Middle East, mostly around banking and financial sector. Even in the US, I had a stint working with CitiMortgage for almost two years, and then the project ended and we were looking for a new project. I landed a new project at Columbia University Medical Center. I did not know at that time how lucky of a break that was because I landed at the biomedical informatics department, a pinnacle of informatics research back then and even today. That’s where I first entered healthcare by accident, but then decided to stay in. The clinical research part, clinical trials management—all that was new to me but interesting. We also developed solutions which we deployed at New York Presbyterian Hospital for patient care. That was my first exposure to what bench to bedside looks like, and that really solidified my interest to stay in healthcare.

I was part of the Epic transformation journey for many years, as HSS grew and made collaborations with other hospitals like Stanford in Connecticut, Florida Tenant Hospital, and New York Presbyterian. I was part of clinical integration and external integration workflows. It was a great stint at HSS, and then an opportunity at Englewood to manage all aspects of IT as CIO. This broadened my horizons further; application was my home base, but I also took over cybersecurity, infrastructure, and networking, led modernization efforts around infrastructure, storage, servers, data centers, disaster recovery, and built the cybersecurity program. This gave me a holistic experience, and that has been my journey—23, 24 years in strictly healthcare organizations.

Q: That’s awesome. So could you please share with us in the aspects of this journey with us in terms of what are the digital health programs that you kind of like, were very close with and you, you kind of have oversee, and what have you been your current priorities? Any recent deployments and any outcomes that you have?

Inderpal: Yeah. So my digital health or digital transformation journey really started at HSS. HSS was a two-part, right? There was a huge emphasis on operational efficiency because we ran 39 ORs. The more efficiently we ran ORs, the better it was for patient care, for business, for the organization.

So we started with this whole concept of a command center, a digital clinical command center and digital twin, which was a very new concept back then, to really look at and run models on operational efficiency, clinical efficiency, clinical care, and outcomes. That journey started there for me.

In parallel, HSS was also doing what was typical digital transformation of patient outreach, patient engagement, and front doors. Then COVID came and kind of brought a screeching halt to that journey. But lucky enough for me, I was also working in parallel on a very innovative solution for digital pathology.

As you know, radiology has been digital for ages now. We don’t even know what film x-ray looks like, but pathology is still on glass slides and microscopes. That is one thing I wanted to change, and I found the right champion in my chief of pathology. Together, we put through a program, almost a year and a half of development with Epic, our PACS vendor, the scanner vendor, and my team, to develop a digital pathology solution, which wasn’t FDA approved then, so we couldn’t use it for primary diagnosis. But then they applied for FDA approval and once FDA approval came, we were ready to hit the ground running. You talk about outcomes—this is where the outcomes were significantly faster because of the situation we were in.

During COVID, within a year, 70% of all pathology cases were being diagnosed digitally. Huge change for an organization or for a group of physicians who have always been tied to the microscope. It also offers better patient care because now the radiologists, the pathologists, the surgeons, the infectious disease doctors all can correlate images—both radiology images and other ologies—which was not the case before; they had to sit across a double-headed microscope. And of course, for teaching, for research, for second opinions. And then, back in 2021, we did not have it, but now all of the tools are layering on top of it, because digital pathology lends itself to a lot of AI tools. It’s about cell counting, pattern recognition, quality of diagnosis—all of that could be improved and normalized across the institution with the tools. So a really great program and I’m very proud of it, and that happened to be the first in the country back in 2021.

And then I carried on the same digital journey when I joined Englewood. We initiated our whole digital transformation strategy. It was a three-pronged approach: patient engagement and patient self-service; clinically integrated care—because Englewood is a large physician practice organization, 700 physicians in practice across multiple specialties—so we feel it’s much better for us to take care of a patient and we can take care of the patient much better compared to sending the patient outside because of the availability of all data and historic diagnostics for the patient within our system; and then the third piece of that was when the patient is not with us—how do we continue to manage the patient remotely?

Since you talk about outcomes, I think that’s most exciting for the team. As part of our digital front door strategy—the typical patient self-scheduling, rescheduling, request for services—we saw about 18 to 20% increase in online scheduling of appointments, and that number was consistently rising.

The big challenge with that is not technology. It’s aligning the physician organization to open up schedules for patients. Then we ran campaigns for patients. This was post-COVID. A lot of preventive care was put on a back burner by patients, and those campaigns were delivered digitally through Epic’s CRM product. So really no manual assembly and actionable text messages. For first-time annual overdue screening mammograms, we saw a 21% success rate—huge in this case. For first-time screening, we saw 6%. So you’re reaching out to your eligible patient population, and once you set the campaign, it’s really in auto mode. From that point, the patient gets a text message which is actionable: schedule an appointment, move on. Then we extended this to colorectal screening and lung cancer screening. All of them saw at least 7 to 10% success rate. It looks like a small number, but we were doing these campaigns via paper and were not seeing anywhere close to this number. A 10% success rate is huge versus not getting anything.

Another aspect I talked about was when the patient is not within our four walls. So how can we take care of them? We initiated a remote patient monitoring solution integrated with Epic. That’s key—so the physician has the data back in Epic. That program saw success. It was for blood pressure monitoring initially, and 84% of the patients who were part of the program within the first six months saw better numbers—not on any new meds or anything, but with active monitoring, care coaching, and the new technology. We saw a trending line which was better than before—positive trending for those patients. So early success factors there.

Then, this was all around patient care, and we also started working towards physician burden because they’ve been overburdened with all the technology we have laid out. So ambient charting was one of the products we rolled out in our physician offices, and ambient charting has a three-pronged benefit: for physicians, it’s timely documentation, real-time documentation, and being able to spend more time with the patient. It saves a few minutes in an appointment. And what does it mean? It means you’re not staying up late and using your pajama time to do documentation. We saw a 40% reduction of that time for the physicians who were using ambient charting.

The other benefit for ambient charting is better coding. Englewood was at the top quartile to begin with, so we didn’t see better results there, but I read statistics the other day at a hospital in Iowa that was saving an average of $13,000 per physician per year because of the ambient charting product, and most of the recovery was with better coding and charging. HCC coding resulted in $10,000; E&M coding resulted in $3,000. Huge number, and a huge physician satisfaction, even patient satisfaction, because the physician is talking to them. We saw those benefits.

Then we worked on a lot of other back-office functions. We’ve all been very fast at reaching out to physicians via MyChart messages. That burden is huge on physicians with everyone sending those messages. So we put in an AI tool—augmented response technology in Epic—to draft and generate a response to the patient based on the question, chart history, and what the patient has asked in the past. That is again an efficiency function. A quick chart summarization—you’re seeing a patient after a long time; you don’t need to click through the chart— a quick chart summary will come up with all the pertinent things. Then we also moved back-office functions like denials and appeals letters and prior authorization. This is a combination of RPA and some generative AI, but the outcome is important for all of these.

Q: That is cool to know. So obviously, during all these initiatives, there would be challenges in building and delivering the digital capabilities—whether technology, people, resources, or process. What are some of your learnings there, and what could you share with the audience on how you surmount these challenges?

Inderpal: Challenges are many. I will classify them as technology challenges, process challenges, and resource challenges. Technology challenges, for the most part, we are able to overcome, but what we call technical debt sometimes gets in the way. Technical debt is not necessarily obsolete operating systems and obsolete technology. Sometimes technical debt could also be in the form of how a modern system was built and deployed when we didn’t plan for digital transformation a few years later—how appointments were established, appointment types, or departments were established in a solution. All of those build decisions, if they were not planned with a digital lens, will require us to go back. And that happened with us. We had to go back and fix it. It wasn’t about a technology solution.

Sometimes the technology debt comes in if your data architecture is not where it needs to be—you don’t have your right data definitions. We want to make data-driven decisions, and for that, we need to be aligned and have confidence around the organization’s data. That’s one challenge for most organizations.

Then the other is moving your organization—executive and operational leadership—onto an agile process. The first thing I prepared my organization for was: be prepared to fail occasionally. Everything will not be a success because we are not dealing with an ecosystem like big vendors like Epic and Cerner, where it’s a proven thing and it’s a 12–18 month project and we’ll have success at the end of it. We are dealing with an ecosystem where there are a lot of new players in the market. They have promise; some will pan out, some may not. But the good thing is that we will not wait 18 months for the outcome. We will be agile. We’ll try for three months, measure the KPIs, and make a decision. That’s a mindset change for an organization. Once a project is authorized, it’s difficult to walk away from it. That’s one challenge.

Then resources. We are all short-staffed and our resources have a full plate, but are very dedicated and specialized. Now, suddenly in digital, we’ve been used to working in a controlled environment until about five or six years ago. We know the clinicians, how they will use systems; we map their workflows; we build a system according to their requirements. But now you’re dealing with an uncontrolled environment of the patient. You don’t know how they will use it. Suddenly the UX design, the patient engagement piece—your teams have to learn about it, think about it, and the environment they cannot map. They can only predict as a consumer how they will use it. That is a big challenge for resources—not necessarily just a resource gap, but also the mindset change for your teams.

So most organizations are building separate digital teams which have more ear to the ground in terms of what consumers are looking at and are also looking at other industries and how they’re utilizing. I’ll end with one thing: every patient understands—me and you—that seeking healthcare is more complicated than ordering a meal or hailing a ride. It doesn’t mean we don’t want that with healthcare. Deep inside, we all want that kind of convenience, and I think that’s the big challenge on the other side of providing that level of convenience, which is unfair to say because it’s a lot more complex—but still.

Q: That’s true. That’s a good vision, Inder. Moving on to another topic, I wanted to touch upon the role of EHR versus non-EHR platform choices and what that means in the healthcare setting. You make a lot of decisions; you’re grappling with a complex system with lots of enterprise software. Any thoughts there?

Inderpal: I would say this—I’ll answer on both sides. First, my responsibility and everyone else’s is to maximize our investment. If I’ve already invested in a solution—and it’s not just dollar investment, but team, resources, and knowledge investment—and there’s a function offered out of an EHR solution, it’s better because it’s already integrated in the workflow. It will not require relearning a new system and may deliver the same value. That’s the good part. I’ve increasingly found it often turns out economical because the base is all there. The downside is being bound by an EMR/EHR vendor’s product life cycle. To be fair, they have a much bigger responsibility managing the entire hospital: clinical documentation, compliance, patient safety, efficiency. They consistently improve their product as that’s their focus. Customers ask why their million-dollar product doesn’t do certain things. They add modules. They are torn where to focus. Their primary focus has to be patient safety and core system functions. That tussle always exists and may or may not work for me, depending on my timeline.

If I go third-party, we all have been there. Best-of-breed solutions focus on one to three matching functions—often done better—but then integration with EMR is essential, or there’s no utility. There’s added cost, team training, etc. It depends where you are on your journey. Every organization is different. If you absolutely need, say, a patient campaign function with clear ROI, it makes sense to invest. That investment can be interim until your EMR adds a similar solution or maybe never. I think the value is timely implementation and deriving clinical and business value from the solution. If your EMR vendor’s timeline aligns, it’s a good choice. More often than not, the functions you need are in third-party solutions and need evaluation for longevity and business sense. I think both have significant roles and will continue to.

Q: That’s a good point. I like how you said that if a third-party solution integrates with the EMR/EHR, it has more value. 

Inderpal: Oh yeah, that’s the sign nowadays. Otherwise, no technology leader would entertain a standalone solution. 

Q: Yes, integration is key. Now, coming to the fun part, no podcast is complete without AI, GenAI, LLMs, and all these agentic AI things. Where do you see the future of digital and AI transformation? What are some things you are currently or looking to focus on in the future?

Inderpal: Sure. I was listening to someone the other day say that, like everything else, AI had a hype—blockchain had a hype, everyone had a hype. It won’t do everything for everyone, and I agree at a high level. But it’s here to stay and scale. Healthcare did not wait on the sidelines. We all wanted to jump in, even if limited, and most healthcare systems use at least some tools in the space. I use a few; everyone does. Right now, we’re doing what I call low-risk patient engagement, self-services, scheduling—all of those things. That’s how you want to dip your toe in the water. For my GenAI-based virtual agent, initial use cases are appointment scheduling, rescheduling, info requests, payments—no clinical data. That will continue to evolve; this is normal in other industries. I was trying to get services from Verizon yesterday; their chatbot and virtual agent were great—I didn’t need to talk to a person. It’s everywhere; we will get better. Integration and alignment are key to offering those services to patients, so that’s here to stay.

Ambient documentation is here to stay and will be all-pervasive. It’s already beyond physician offices—to inpatient rooms, nursing. Eventually, ambient and dictation systems will merge, become redundant as separate systems. Ambient will continue evolving over 12 to 18 months. Workflow alignment will come. Technology is already aligned and giving benefits; workflow alignment is required to best use it and get outcomes. My long-term guess is that in 4 to 6 years, clinical use of AI will be a differentiator.

The pinnacle will be personalized medicine. We talk about it now—dosage based on population sectors. Personalized medicine is probably the pinnacle, but before that, point-of-care recommendations and decision-making will be reality in 4 to 7 years. Agentic and agent-based AI will take root in many back-office functions, which have many manual processes that can be automated. RPA did some, but now agent-based AI will ramp up.

Digital twin technology is cost-prohibitive today but could be a game changer for personalized care and letting health systems try things rather than run long pilots. If widely adopted in healthcare solutions, digital twin could speed design changes and implementations faster than parallel testing and pilots.

Q: True. We’re seeing a lot in the agentic AI space, personally and at BigRio, with clients including voice agents. 

Inderpal: You’re right. We did omnichannel virtual agents—voice, text, and web—with Zoom, Epic, and Amelia. I saw your agentic AI webinar recently; very cool. I personally haven’t used agentic AI but would like to try it. Sometimes it looks too good to be true, but it’s happening in real time and performing roles. I wish to try it in the next months or years.

Q: Awesome. Thank you for sharing your thoughts and vision on this podcast. Any parting thoughts to wrap up? 

Inderpal: I read a quote recently that stayed with me: “AI won’t replace clinicians, but clinicians who use AI will outperform those who don’t.” I think it’s for everyone. Real transformation isn’t about tools; it’s how we imagine using them, how care is delivered, and how patients experience interactions. An AI agent can’t do that alone—it requires humans: clinicians and operators. That quote stayed with me.

Q: That’s a fabulous quote. I’ll end by saying we have an exciting partnership with a startup to bring AI at scale to healthcare systems. You know what I mean. So yeah, very happy to, uh, collaborate with you in there on that as well later on. So thank you once again and have a great day and we’ll catch up soon.

Inderpal: Thank you. Thank you for the opportunity and thank you to your viewers.

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 Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.