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

Rohit: Hi Ashis. It’s great to have you back on the Big Unlock podcast. Thank you for joining us, 

Ashis: Rohit, Ritu, it’s wonderful being back. It’s been a few years and I’m excited to join again. Thank you for having me.

Rohit: Thank you, Ashis. As we discussed before the podcast, we are carrying on Paddy’s legacy and are very fortunate to be doing so. Our podcast is now more than 170 episodes, so we have a very excited base of listeners for this interaction with you. I’m Rohit Mahajan, Managing Partner and CEO at BigRio and Damo Consulting, based in Boston and host of the Big Unlock podcast.

Ritu: Hi Ashish, really nice to have you on the podcast. Welcome. My name is Ritu Roy, Managing Partner at Big Rio and Damo Consulting, currently based out of Gurugram, India. Looking forward to a very engaging discussion. Thank you for being here. 

Ashis: So good to be here. Thank you again for having me. I am the Chief Digital Technology Officer at the Hospital for Special Surgery, which is a hospital on the Upper East Side of New York and the tri-state region on the East coast. We specifically focus on musculoskeletal care. You may know us as the orthopedic surgical hospital, but we actually have the largest rheumatology practice in the world, as well as psychiatry and other aspects of skeletal care, so we provide the full spectrum.

I started my career in Texas and I am a pediatric gastroenterologist. I’ve never stopped practicing and I practiced for a long time at Baylor Scott and White, which was the position I held when I was fortunate enough to meet Paddy long ago, where he became what I consider a friend.

I told him long ago, the Big Unlock was absolutely the main podcast I listened to—one of the first I started listening to when I wanted to learn about digital health. I was a frontline doctor and felt that digital health was going to be something significant for healthcare. Before people really knew, I think Paddy was onto something, and the fact that he made it his mission to talk about it, to educate, and to really move the field, is inspiring still. I think that has really created this forum of where it is now.

When I was at Baylor, I was fortunate to be at a system that was very far ahead in the virtual and digital space. I then moved over to Highmark and Allegheny Health Network as the Chief Digital Information Officer. I did that for a few years—a fantastic time. I learned about a whole new world as a doctor: insurance and value-based care specifically, and was able to make a lot of great programs there and do a lot of good work.

Then, when HSS came calling—which we can talk about more in the podcast as to why I made the move—I jumped at it about 10 months ago, and it’s been the best decision of my career.

Rohit: That’s great to know. Ashis, so very curious. You said that you never stopped practicing, right? You are looking at digital transformation initiatives at one of the largest hospitals in orthopedics and MSK in the New York area, which is one of the largest states. So how do you balance it, Ashish? That is one of my questions. And second, what motivated you in the first place? I know that you started your work as a physician, but what motivated you to become a physician? Please share that story with us as well.

Ashis: Oh gosh. Okay, so I have trouble with brevity at times, so I’m going to do my best. It’s a big question. Let me start with the latter and then you can remind me the former. As far as being a physician—and you said balance—I don’t believe in balance anymore.

One of my favorite books is Conscious Business. One quick premise of the book is that work-life balance is kind of like eat-life balance. You eat as part of life and you don’t really think of it as separate. Sometimes you have to stop to eat, sometimes you really enjoy the meal, and that meal can be at 11 o’clock in the morning, or it could be at nine o’clock at night, or anything in between. The point is, if your passion is your work, then there doesn’t have to be a line between the two. There are times in the day when I can take my son to a game at 3:00 PM and that’s okay, but then I may be working at nine o’clock at night, and that’s okay too. The balance aspect of things is always a struggle, but I think that if you strive for balance, you’re maybe focusing on the wrong thing because you probably don’t have balance with what you’re doing at work. Does it feed you? Does it give you passion? Does it give you energy? I don’t have a problem with it. My wife may argue at that point, but I don’t have a problem with it in the sense that my work is my passion. It’s what gives me energy, it feeds me, and I enjoy it.

I think before the podcast, you told me that when you met me the first time, you didn’t get too many words in because I was speaking with such passion and energy and fervor about what we were doing. That’s just me. I apologize for that, but that goes to show how much I really enjoy the space. My life is my work, meaning my kids, my wife, the dog, and everything else comes with it—just as passionate, just as energetic—and they melt together.

All of that being said, I’m a doctor first. I’m absolutely a doctor first, a technologist second, and I am to this day. I think that’s a differentiator. I think it’s a bit different than most people with my titles and roles, and I hope that brings a different perspective and value to the equation and discussions. I grew up during the High Tech Act and turned on a lot of Epic systems and what have you.

To answer your question directly about why I became a doctor: I am the first doctor in my family. So that’s not a typical Indian answer—many doctors and engineers in Indian families—but my parents immigrated right before I was born. I was born in Chicago, we moved to Texas when I was little. I’m an ABCD kind, if anybody knows that term. I was born in the States and grew up in Houston, and it was a passion from the get-go. I always knew I was going to be a pediatrician. I really enjoy families; I enjoy working with kids. That was something I just gravitated to, and there was never a question of anything else—pediatrics was something I wanted.

The other side of it is, we took a family trip to India when I was a kid, around eight years old. I actually contracted typhoid fever when I was in India—salmonella typhi. It’s very significant, and I was in rural India at the time. It was misdiagnosed as malaria and I was being mistreated. As an eight-year-old skinny Indian kid that maybe weighed 60 or 70 pounds at best, I lost 25 pounds at that time, and I was actually very close to passing. By luck, my cousin was marrying a physician in India—Manish, who lives in Ohio now. So, Manish, if you’re listening, you saved my life. Manish knows this. At every wedding we see, he says, “You’re alive.” To this day. Manish Bai came by because he heard that I was ill and he quickly figured out that I had typhoid fever. He brought me to his home, treated me, and I was able to get the right treatment and get back to the States. Obviously, I’m here and well.

That played a significant role in my life; I wanted to be a doctor like Manish—he is a family practice doctor in Ohio now. Pediatrics was something that resonated with me because I was a kid at the time. It plays a big role in who I am today. I received the wrong care, I didn’t have access to care—I received the wrong care until I got the right care. So the questions are: how do we distribute, how do we democratize, how do we get the right care to all people? Again, being at that age, I think it was a profound effect on me.

Rohit: That’s an amazing journey, Ashish. Thank you for sharing that background and insight. And Ashish, that brings us right to the persistent challenges in healthcare. We all kind of know what they are. I have a laundry list here: limited access, rising cost, clinician burnout, admin burden, and systemic waste. There are many persistent problems that we are trying to solve. I think we are making great progress on several fronts. How do you think about your digital transformation efforts at the current organization and what you have done before? Can you share with us some thoughts and ideas on how you approach this and what solutions you’ve been able to put into place to address these?

Ritu: Yeah, just before you answer, at Human X, there was a panel and a very interesting perspective on this—how slow things are in medicine, and how it takes years for doctors to adopt new ideas. Even the stethoscope took many years before it became acceptable. Because you bridge that gap between being a doctor coming into technology—when you address these problems, do you feel you have to address the issue between how technology moves, especially now with AI moving at light speed, and how things in healthcare move slowly? Is that frustrating for you? I just wanted to bring that in.

Ashis: Now you know that they have long-form podcasts that go on for 48 hours. There’s so much there. But knowing this is not one of those, let’s keep it succinct but try to create value in my answer.

A short answer—frustration—or it’s one of those things: how do you look at it, and do you see it as an opportunity? Do you see it as something we can really go do? The short answer is the time—even best practices. The amount of literature is doubling at a rate that is unreal. As a pediatric gastroenterologist, I can’t read enough journal articles to know what is published, let alone keep up with MSK, orthopedics, and everything else. There just aren’t enough human hours in the day, with all the other burdens of healthcare. There’s much more data and information constantly coming up. The average time for a physician to put a journal article or best practice into practice is something like 16–17 years.

Then, the innovation timeline—from something being invented to being used at HSS—is very long. The first knee implant was invented at HSS; it’s a culture of innovation. But by the time things get invented and then widely used, that timeline is massively long. How do we shorten that? I believe AI can significantly shorten that journey, especially with cognitive knowledge—getting best practices to pop up in the care journey, nudging clinicians when new evidence emerges. That is 100% doable, and you’re already seeing some vendors partnering to bring that insight into the workflow. That excites me.

For the broader question of digital transformation, there are many ways to frame it. The very broad way: how do we improve clinical outcomes and reduce administrative waste? Generally, let me zoom out and say—I was talking to an academic professor recently, and she said, “The only two things we should be talking about in healthcare right now are Agentic AI and change management.” To some degree, you can debate that, but they impact all aspects of healthcare.

I’m a techno-optimist, but I don’t just want tech for the sake of tech. I want tech that works, that actually solves problems. When I was a frontline doc, there was so much tech thrown at me, supposedly logical and great, but people didn’t realize it added burden to my workflow. So, part of my journey is representing the front lines—knowing what problems actually need to be solved. That takes a lot of listening, learning, and observation.

What excites me most now is Agentic AI. Healthcare is about workflows—it’s not about a moment in time. No doctor, nurse, patient, or consumer spends their healthcare journey in just a moment. Point solutions and things like generative AI chatbots still solve only moments in time. If I have a rev cycle authorization tool, or an ambient scribe, or an OR dashboard, that’s only solving a moment. But in healthcare, problems have downstream and upstream effects through workflows.

When I think about Agentic, it’s a workflow orchestrator—something that hasn’t existed outside the EMR. Of course, EMRs have workflows, but with lots of friction and clicks. Agentic has the potential to be a workstream orchestrator for everyone—consumers, operators, clinicians, administrators. This orchestration is where the magic and value will be, because every handoff in healthcare—from scheduling to aftercare—is where friction and waste happen due to lack of coordination across silos.

I believe as we solve across, and make the “white space” between verticals go away, we improve experience, coordination, and outcomes—and reduce cost. But that world has to be purposely built—it won’t magically appear from a platform or from thousands of point solutions that somehow orchestrate together.

My teams are working on that, with the first part being our data. We are building Lakehouse architecture—making sure our source of truth is in one place, linking all the data within context. Whether it’s consumer data, finance, operational, HR, clinical, wearable data, etc.—with all that linked, an agent system on top can orchestrate to take real action, which can then inform humans.

Lastly, it’s important I say all this is not to imply that there will be fewer humans in healthcare. If you’re touching a human, if you’re in front of a patient, we need to double down on that. We shouldn’t orchestrate, automate, or agent that away. Rather, we want to take away backend processes so we can double down on human engagement at the front end. The question is: what should be done by humans, and what by AI? Change management—upskilling, reskilling, onboarding—really means asking what needs to be human and what is best done by automation. That shouldn’t create fear that there’s loss; I think there’s actually gain—more time with patients, more humanized healthcare. I genuinely believe, if done right, AI has the potential to actually rehumanize healthcare.

Rohit: That’s true. 

Ritu: Great answer. Ashish really hit the nail on the head there. 

Rohit: I think it’s a different way of thinking, like you said, Ashish, about workflows, change management, Agentic AI, and all the white space that can be filled in. Would you think of any possible example? This data preparation that you’re building in the lakehouse is not a trivial effort. It’s going to be, possibly, a multi-year journey. And now you’re layering agent AI on top of it to fill this white space and orchestrate everything in the workflow. So is this too far in the future or near, and what are you seeing in terms of timelines? Also, in change management, what are some of the challenges you’re looking at, and how are you possibly overcoming those?

Ashis: It’s a great question and I understand the essence of it. This comes back to why I am at Hospital for Special Surgery. Let me frame that first, because I think it’s important. I was at much bigger companies, in terms of revenue and size. There’s a very purposeful reason for my move, based on my learnings. One of the struggles—and it’s understandable, especially since I’m very mission-based (as you may recall, I once said we’re missionaries, not mercenaries, and I still hold true to that)—is that healthcare is so complex. We all know that. Healthcare is complex due to the human factor, payment complexity, and more. In big systems, what’s harder is orchestrating between cardiac, cancer, peds, and different geographies and cities. What you described could take five, ten, even twenty years—it’s like boiling the ocean; it’s massively complex. You end up being one inch deep on everything and don’t know where to start. If I go to another system, do I start in cardiac, cancer, or orthopedics? No one wants to be second or eighth on the list; there’s politics and competition among divisions, with everyone wanting priority.

Healthcare is now hyperspecialized—doctors think inside their narrow specialty, which sometimes holds us back from thinking more broadly. The “focus factory” that is HSS—just doing one thing and doing it at a superb, world-class level—is very important. It lets us go deep, which is extremely difficult for broad systems. Even though orthopedic and musculoskeletal care isn’t super narrow (30–40% of people have mobility problems, so the impact is great), we get to go deep in one specialty. A lot of what we do is elective and algorithmic, which aligns well with Agentic AI.

So for us, there’s a bit of a perfect storm of positive aspects: we are the best at what we do, focusing on one thing, and it’s highly algorithmic (while still having plenty of human factors). I believe what I’ve described has a timeline of two to five years, rather than ten to twenty. At HSS, my and my team’s hope and vision is to create a very talented team to do this. We’re building a lighthouse for what is possible in healthcare, to show the world it’s possible to automate backend processes and orchestrate workflows. Our mission is to show that this role is possible—because of this focus factory aspect and being the best at what we do—and then distribute that globally.

If we codify the knowledge base that’s here at HSS, the best at what we do, why can’t AgTech orchestration distribute that, not only across rural America and the US, but also the globe? It can be codified. We really see ourselves as having an obligation to take what’s incredibly special at HSS and extend it. When you walk into HSS, you feel the experience, passion, and outcomes—it’s incredible. The question is, why is it only those living in the tri-state region who get access to what healthcare should be?

It’s really incredible. How do we take what’s so special, these care pathways, and this innovation, and broaden that knowledge, education, and capability globally? If we’re at the tip of the spear—using AI navigation, robotics, and other aspects of musculoskeletal care—then we want to broaden that knowledge and ability for everyone. 

And you know it, and the surgeons and the rheumatologists and the nurses at every level, an exceptional and it’s, you know, for me. It’s, why is it only if you live in the tri-state region, do you get access to the, what healthcare should be? 

And you know it—the surgeons, the rheumatologists, and the nurses at every level, they’re exceptional. For me, it’s: why is it only if you live in the tri-state region that you get access to what healthcare should be?

It’s really incredible. How do we take what’s so special? How do we take these care pathways? How do we create this innovation?

If we have something we’re able to use at HSS—and we are at the tip of the spear, using AI navigation, robotics, and other aspects of musculoskeletal care—how do we broaden that knowledge, education, and ability across the globe?

Rohit: That’s amazing, Ashish, very admirable vision. For those people on the podcast and for myself, I’m curious to learn a little deeper—it’s a more tactical than strategic question at this time, but you mentioned algorithmic. Could you throw some light on what you mean by that?

Ashis: Let’s talk to that quickly because I don’t want this to sound like just medical futurism—like, “oh, in 30 years we’ll do it.” How do we get there? As I said, data architecture is super critical, and one thing I’ve learned, and for which I’ve hired significant talent, is really focusing on the data. From my position, growing up as a doctor first, then becoming a technologist, everyone talks about the wonderful things, but what’s step one? Where do I put my first foot down? It’s very difficult. What I implore anyone on the podcast: really start with the data and make sure you have a data strategy that allows you to put an agentic system on top of it. The capabilities are there, the tools are there, but the context may not be. You have capabilities like OpenAI—now they’ve launched ChatGPT agents, it’s incredible. That’s the capability, but it has no context, no data to inform or make an intelligent decision. We need to get the context right, which is getting the data right. First step is making sure we get the context and the data right, and we’re centralizing that.

The second aspect is that we’ve made key partnership decisions. This is not something we’re going to do alone. We’ve made some key partnership decisions to bring big tech and startup innovation into our ecosystem. I’m a big ecosystem fan. I think it’s going to take an ecosystem. So, this week and others, we’ve launched ambient listening—it’s not just listening. We don’t see it as only ambient listening. Describing is only the first step. Having the scribing inform coding, CDI, authorizations, scheduling, even CRM tools—this is how we see the platform going forward. We’re looking at that.

Secondly, we’ve partnered with Palantir. What is Palantir doing for us? Palantir is thinking through the journey from end-to-end, from a consumer lens, from the beginning of care to orchestration. From operational flow, from a business intelligence standpoint—though that term minimizes it because it’s much more than that. It’s creating a kind of GPS—I want to define the main road of care, and when you get off the path, the GPS system activates to get you back on the main road. I think of Palantir building that with us.

Third, I’m a strong believer in low-code, no-code for the masses. Palantir is pro-code; it’s heavy and not something I can just democratize for any employee. So I need another agent layer of low-code, no-code. I think the future of work in healthcare is operator and engineer, unlike when I was a pediatrician and had a great idea but had to put a ticket into central IT, then wait six months only to be told it’s lower priority. I knew it would help my patients and outcomes, but I didn’t have the tools to build it in a safe, secure, PHI/HIPAA-compliant, easy workflow.

I think that’s changing. If I have an agent platform, from a coding perspective, I can say, “Here’s what I want,” and that’s what’s changed. OpenAI gives coding ability to everyone—it’s in plain English, written or verbal. So now, why can’t my revenue cycle folks build their own workflows? Why can’t my surgeons? That’s real capability. Why doesn’t it work today? Because the data is siloed. If they build an agent for calling post-op patients, another for collecting prompts, another for getting access, that’s like five different phone numbers—they’re not orchestrating. It goes back to vertical agents that aren’t orchestrating care, creating more friction and cost.

So, the answer is orchestration—having one agent platform for the enterprise and making sure the data is structured so it allows orchestration of those agents. So, it’s ambient, our Palantir work for high-code, and then an enterprise orchestration platform as well. Those are the three partnerships we’re building.

Rohit: That’s great. So Ashish, I think we’re coming towards the end of the podcast. As you said, there is so much to talk about—it went by so quickly and was a very different perspective. Would you like to offer any parting thoughts? Hopefully we’ll have you back soon to build on what we discussed.

Ashis: It’s important to me that we have a responsibility to transform healthcare and make it better. While I think about AI and agents—Dr. Michael O’Hara, our chief data analytics officer, always says there are two E’s in AI and everyone forgets the second. The first E is efficiency—everyone talks about that. We need more efficiency in healthcare, but I think we miss the ball if we only focus on one E. The second E is effectiveness. We can do better than we do today. It’s not just about doing things efficiently; the goal is to actually do better. People have unmet needs, lack access, or get the wrong care more than the right care. We need to do better—not just efficiently, but more effectively.

Hospital for Special Surgery does the best at what they do, and that’s true. What we’d love to do is ask: what do we do better, how do we codify and share that, and help make healthcare more effective in musculoskeletal care? If we can package up what’s special at HSS and make it a global brand, we should do that. Lastly, even though “surgery” is in our name, we actually do more non-surgical than surgical care at HSS—not many people know that. We live in the world of movement, and people care a lot about movement—wearables, watches, step counts. When you lose movement, you lose much. A lot of healthcare is about loss—loss of function, cancer, chronic disease—but what excites me is that musculoskeletal care is about gain. People want to move better, play with grandkids at 80, run marathons at 60, live better and longer. The number one component of longevity is movement. You don’t want to be 120 years old and wheelchair-bound—you want to be active. So we’re thinking more broadly—movement, not just orthopedics. I’ll leave you with that. Thank you.

Rohit: That’s awesome. Thank you so much, Ashish. It was pleasure having you on the podcast. 

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