Central Line

Episode Number: 125

Episode Title: Innovation

Recorded: March 2024

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VOICE OVER:

Welcome to ASA’s Central Line, the official podcast series of the American Society of Anesthesiologists, edited by Dr. Adam Striker.

DR. ADAM STRIKER:

Welcome to Central Line. I'm Dr. Adam Striker, your host and editor. Today we're getting innovative with Dr. Irving Ye from ASA's Committee on Innovation. He's here to talk to us about where the specialty is headed and some of the innovations that will make an impact on our patients and our practices. Certainly a fascinating topic, a timely one, and I'm definitely looking forward to jumping in. So Dr. Ye, thanks for coming on to the show.

DR. IRVING YE:

Well, hi. Thanks for having me here.

DR. STRIKER:

Absolutely. Well, to get us started, why don't you tell us a little bit about yourself and how you got interested in innovations?

DR. YE:

Well, great. Thank you. I'm an anesthesiologist with Northstar anesthesia, and as you said, I am representing the ASA's Committee on Innovation. A little bit about my background. I started as a medical director at a large practice and then became one of Northstar’s regional chief medical officers. Today, my role is the Vice President of Clinical Transformation. And my job at a very high level is simply to try and make it easier for our clinicians to take care of our patients and to to run a good anesthesia business along the way. When I'm not doing that, I also work with some startups and health tech companies. And as the head of Clinical Transformation and Northstar, I get to work on a wide variety of projects. They range from provider experience and clinical quality to clinical documentation and revenue cycle, which may be less sexy but equally important. And so there's a ton of opportunities where I do work that's, you know, tries to be creative and innovative. I focus a lot on technology, a lot on new processes and building new systems. So, uh, hopefully I'll share my experiences and what I know and provide your listeners with a with a good perspective here.

DR. STRIKER:

Before we get into some of the specific innovation topics, if you don't mind, just refresh our listeners what the committee on innovation is charged with doing in the ASA.

DR. YE:

Certainly, the ASA committee on innovation has a few major objectives. Number one, it is to inform our anesthesia committee about innovations within our specialty. And secondarily, we want to provide resources that can support, inspire, empower the people in our field, the anesthesiologists out there who have ideas to go out there, work on them and be successful.

DR. STRIKER:

Okay, great. It's going to be interesting to talk about because technology is rapidly changing. And I think now probably more than than any time in recent memory, it's going to have a significant impact on all of our professions, jobs, our work. And so let's start going over several broad areas that you think, as far as anesthesiology is concerned, will benefit from innovation or be affected by innovation.

DR. YE:

First, just to touch on clinical care, I think there are a lot of advances there. And then, uh, also education and leadership, how we're preparing the next generation of anesthesiologists. Finally, I think a third topic would be what I do most of my work on, which is around practice management. That's an important area as well, because given the current health care landscape with staffing shortages and economic challenges, it's an area where we all really need to be thinking creatively within our specialty about how we manage our anesthesia groups.

DR. STRIKER:

Okay. Well, let's start with the first topic, and that's clinical care. Why don't you go ahead and give us some examples of things that you see or foresee, either affecting the way we currently practice or our targets of areas of improvement with regard to our practice.

DR. YE:

So I think there are a few really exciting areas in preoperative care. I think the ability to risk stratify patient, I think thinking about how to optimize and prepare the patient. And then there's a real opportunity for patient experience as well.

How we do the risk stratification and sort of patient optimization is based on the information that we get from the from the patient experience. So so we need a great pre anesthesia experience. I think telemedicine is a major innovation here. I know it's over the past couple years, it's not necessarily new. But certainly there's a lot that's evolving and a lot that's going to evolve, um, as we continue to adopt it more and more in the post-Covid years. So we know there are some problems with it. But preanesthesia evaluations done remotely has been shown to be safe in providing patient care. It reduces cancellations, and we know that it makes it easier for for patients. So it's a win win in many cases. And I think we'll continue to, uh, figure out ways to use that and not just our clinics calling the patient. Right? So so using telemedicine, I think we can come up with some other creative ways to get preanesthesia assessments done. What comes to mind for me is what if we evolved to more off site, outsourced versions of the anesthesia clinic? Is there a reason why we shouldn't use, like a Walgreens or a Target clinic, or a Walmart to do those pre anesthesia assessments? We got to ensure the quality there, but if we're going to be patient centric then that would help them, right? And they can get their vaccines and blood drawn there and buy some vitamins and gum while they're at it. So that would be an interesting innovation. Companies are trying to figure out how to centralize and sort of streamline the preoperative assessment. There are companies that are specifically there to do pre anesthesia assessments. They are remote, they use telemedicine, and it's innovative because they're providing an outsourced solution to all kinds of customers surgical centers, hospitals, surgeons who may not have the academic level dedicated resources.

Another one that I see is the growing collection of wearables and home monitoring and measurement devices. They come in all kinds of flavors now, but the technology there from, you know, basic oxygen saturation probes, blood pressure cuffs, EKGs, now the digital stethoscopes, really fancy scales for weight tracking and temperature. You know, people can even do a lot of labs at home now. And so I think that kind of ecosystem is really going to help make it easier for the patient as we sort of move to less of a traditional in-person physical meeting for the pre anesthesia assessment and sort of go to a more convenient global model to try to get that done.

On the provider side, there's technology that's come a long way to make things easier for us, and that's going to mainly going to be around easing the documentation burden. There's a ton of investment from all kinds of companies -- Google, Amazon that are designing this software that will just make it easier, uh, to create and augment these notes. And so what I'm seeing is, these companies that can help you take a recorded conversation and then convert it to an anesthesia note instantly. Right? You read it, modify it, and then sign off on it. And so there's so many advantages to to saving you that time. So you can actually focus on, on the patient and the actual clinical decision making. And so that's going to be a major step when we get it right. And certainly they're going to be challenges with that.

I’ll also just quickly mention another sort of very cool example for sort of advanced history and physical. There are now instances where people are taking 2D and 3D scans of patient's faces, and airway, and then using machine learning to analyze these facial features to predict how difficult it might be to mask ventilate or to intubate this patient. That's cool stuff. I mean, there's no more disagreeing about Mallampati scores in the future if that kind of assessment can can truly be consistent and accurate.

DR. STRIKER:

Well, you'd focus so far just on the preoperative care. I do want to ask about the other phases. But before we get to those, it's interesting when you talk about consolidating patient care in a visit to a Target clinic or a Walmart clinic and accomplishing a preoperative assessment at that time, how do you foresee that playing out within the anesthesia group that's going to be administering the anesthetic, as opposed to, um, somebody else doing the preoperative assessment, and then that group that probably has certain practice models, certain practice preferences and whatnot, reconcile with what somebody else has has talked to the patient about. Are they going to still repeat some of that work because they don't necessarily have confidence in what has been done? Or am I thinking about this wrong, uh, on how this could really benefit?

DR. YE:

Yeah. So I love what you're asking about there because it sort of leads into another buzzword which is care coordination. And in what you're talking about, sort of outsourcing pre anesthesia, there's got to be a way where we're not necessarily thinking about sourcing, but trusting various teammates to do the right job and do the best job they can. Um, there are already some, some great models of this pre-operative care coordination out there. There are some centers that are building these innovative clinics that have all kinds of satellite enhancements to help this patient through this pre-operative process. So you can't get it all done in one clinic. So they've created an anemia clinic to address low hemoglobin in particular. They go send them off to an endocrinologist or they, uh, want to stop smoking or addiction so a behavior therapist is involved. So going to Walgreens might be another way of well, go ahead and get your review systems filled out there. And we figure out other ways to coordinate all that care, put it together and have the information in one place. It's it's a challenge, but people are definitely working at it. And this is an area where we can definitely make an immense impact in maybe being a quarterback to all this process and coordinating all that care.

DR. STRIKER:

I see. So you foresee the anesthesiologist as filling the care coordinator role?

DR. YE:

Well, I think there's certainly an opportunity there. I'm not sure I'm not convinced that it is the only way that anesthesiologists should go. But we definitely have a role in that care coordination. And the reason I hesitate to go all in is, in some aspects, you know, I've always sort of believed in this, this the coordinator life coach perspective, this sort of a resource that helps the entirety of that person and while we could serve in that role, we are also a critical portion and only a critical portion of of that person's experience. But for the surgical care, we could certainly own much more of that, uh, in coordinating the elements that are specific to that surgery.

DR. STRIKER:

Gotcha. Well, let's turn to intraoperative. Go ahead and cover some of the innovations you foresee or are seeing in the intraoperative phase that's going to affect our practice.

DR. YE:

So the intraoperative phase I think is is an area that's really technology heavy. And I think this is an area where it's much more about mainly devices and software. This is where I sort of like to focus because I'm a gadget geek and I think many of us are. So, you know, basic monitoring devices have come such a long way. And we're just going to continue getting better at them. Pulse oximetry is evolving. It's more accurate now just for, uh, accounting for the various pigmentations of our skin. Um, but it's also sort of moving towards how do we measure more of not just oxygen saturation, but like pao2. Um, and there are devices already out there that that tries to get a lot closer to, to getting to that. And there's this, this oxygen reserve index, which I think is a really interesting concept. Um, they sort of go hand in hand with all these much more present non-invasive, continuous hemodynamic monitors that give you advanced cardiac output and cardiovascular measurements.

Pain is a great, great area. There's a variety of devices out there that look at various physiologic indicators that then try to give us a pain score interop so we can figure out how to provide analgesia. I mean, that could be another vital sign one day. And I know that's certainly been talked about for as far back as I can remember, but the technology is is getting much closer these days.

And then the software portion is, you know, using these devices, getting the data and then having some help in predicting what's going to happen. Many of us are familiar with the hypotension alerts now, intraoperative hypotension, um, using the non-invasive continuous hemodynamic cuffs that can predict that hypotension is imminent up to 15 minutes in advance. There's acute kidney injury predictors. Um, same thing for heart failure. And I think where we're going is that the bigger these models get and the more information that that they get, I imagine that there'll be a point where we'll get sort of this continuous prediction of what the patient's risk for a variety of things are, you know, the risk of post-operative complications, even mortality, readmission. We might be seeing that kind of score as we're taking care of the patient in real time one day, certainly moving in in that direction. And so, uh, if if you don't think there's enough alarms in the OR right now, you should be worried because there's probably going to be, uh, more alarms in the future. Uh, given the amount of sort of information that's being processed to try to help you, uh, make decisions.

DR. STRIKER:

So as someone who's heavily involved in innovation, thinking about innovation and maybe what's on the horizon, how do you foresee the role of the anesthesiologist amidst all this evolving technology, with systems that are smart enough to predict outcomes and prognosticate even? How do you see the future physician in the role of anesthesiology interacting with this technology, specifically in the intraoperative phase?

DR. YE:

Even with the information, you're still going to need someone who is well trained and well experienced, a human being at the end of it all. Let me give an example of what anaesthesia might look like. So there is this place that is trying to look at the concept of an anesthesia control tower, sort of like the airline industry where they direct, you know, dozens of of operating rooms. There's a there's a team there. It's a centralized team. They are monitoring a bunch of rooms. They're having the technology help them assess the risk, constantly monitoring, maybe giving them flags. They're able to make the decisions and see when, you know, when an airplane's not on their flight path. And then the team then makes an adjustment, does what they need to do to sort of intervene and and manage. That's a new concept. People are doing it. And I think it's an example of how we might be a little bit more distanced from sitting in the seat in the OR, but our involvement actually becomes much more critical.

DR. STRIKER:

Well, fair to say that there's already evidence that practice as we know it is shifting, but it's going to continue to evolve. What we think of as kind of classical anesthesiology practice is going to be different in the coming years than we think of it right now.

DR. YE:

Absolutely.

DR. STRIKER:

Let's briefly shift over to the post-operative care. What innovations in that phase.

DR. YE:

For post-op care, I think this is probably an area where there's a ton of opportunity for us as anesthesiologists. In most cases, we are not involved enough in the PACU or, you know, days and weeks after the surgery. How many of us truly know how our how our patients do after the anesthetic that we give? And if we vary things up, how do we know what's the difference that we made? I think that's the opportunity, through data and through new ways of trying to get that information, I think we'll get there. I know that some EMRs are trying to build these databases where we can query the data for quality metrics. This very sort of hard to achieve concept of interoperability, must be achievable. The ease of access to data, which we all have headaches about, that's got to be solved. It's getting better. The EMRs are building ways in which outside parties can access that that data. And we have seen the evolution of features that allow us access to that data. And it's an area that the ASA and the AQI are actively working on for us.

But outside of the EMR, I think the innovations and the opportunities come from engaging the patients directly. These new ways to communicate with the patient and these new devices lends to remote post-operative monitoring, whether that happens on the floor or in the ICU. I think all that is all that's really logical. Outside of sort of the inpatients, I think postoperative monitoring can apply to same day surgery, ambulatory patients, telemedicine. These devices allow us to to monitor these patients remotely in real time. Again, you know, similar with with various predictive flags that then help us with our management. There are tons of devices here. There's wrist mounted pedometers accelerometers. Those things I think already have a use in guiding physical therapy and sort of reminding patients to get up and move and sort of alert them to do their beat or walk or move and things like that. The wearables, you know, you can clip them anywhere on your on your arm, your waist, your ankles. I was actually shopping for one of the rings, trying to check those out. And these are consumer based, but there's the healthcare grade technology should be theoretically even better than that. With telemonitoring, these new devices, I think anesthesiologists have some of the greatest opportunity to to use these innovations to increase their role in trying to manage trying to detect these, you know, non-surgical complications and be much more involved in the post-operative care phase as a whole.

DR. STRIKER:

Yeah, well, that's certainly been identified as a high yield target for our involvement in patient care. Is the the post-operative phase, the post anesthesia phase. Well, we could talk about innovations forever. It is it's fascinating. There's so many different methods, technologies and what have you on the horizon. But I do want to touch base with you on a couple of the other facets of innovation that you alluded to earlier, education and practice management. So before we do that, let's take a short patient safety break. Stay with me.

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DR. SADASIVAN:

Hi. This is Dr. Senthil Sadasivam with the ASA patient safety editorial board. Post-operative opioid induced respiratory depression, or DD, continues to be a costly and potentially fatal problem. Reducing the incidence of I or D requires effective preoperative screening. Patients with obstructive sleep apnea are at particularly high risk of boyhood, and preoperative symptom questionnaires such as Stop-bang can help identify patients who would benefit from advanced respiratory monitoring for patients at high risk use of non-opioid analgesics, or the. Lowest effective dose of opioid can help prevent post operative word for monitoring. Pulse oximetry may not be sufficient to catch early signs of post operative or ERD, and techniques such as cabinet mitre and chest impedance monitoring may be needed. The prodigy risk score, which combines oximetry and capnography, is useful for predicting the risk of postoperative period and identify patients who need closer monitoring. Early identification and advanced monitoring of patients at risk of postoperative ERD is critical to ensure patient safety.

VOICE OVER:

For more patient safety content, visit Asahi Talks patient safety.

DR. STRIKER:

Well we're back with Dr. Irving Ye from the ASA committee on innovation. And earlier, you mentioned two other areas besides clinical care that are ripe for innovation. One is education of anesthesiologists and and others practice management. Let's start with education. How are models of education evolving? Is there anything with the committee specifically that you are engaged in in that respect?

DR. YE:

Yeah. Let me let me mention a few things on education. I'll preface it with I am not an educator nor involved in an academic program, but I have enough colleagues and I do enough training in some of our programs within North Star that I think I can focus us on a few areas that are really valuable right now.

The first is the increasing use of technology and devices. The days of heavy textbooks and backpacks is mostly behind us. I still see them in offices, but I think for most people there's textbooks are still being used. But we've much more migrated to screens, online resources, sort of point of care, Q&A, you know, trying to find answers.

The other really useful technology that's impacting education is simulations and the technology behind that. So that's stuff like virtual reality, augmented reality, the metaverse, that kind of stuff is really allowing students to access simulation tools much more frequently. I don't know how many simulations you did when when you were training. I did not get too many opportunities to do that. I thought they were exceptionally valuable learning experiences when they did happen, right, when we all got into the to the OR and practiced the scenario. Now these scenarios are just so much more accessible. Uh, students can get real world experience much more frequently, and there's not much more valuable, uh, teaching method than real world experience. So that's exciting.

The other somewhat daunting element in education is the sheer amount of new devices and equipment and even medications out there to to some extent. There's, you know, a lot fancier equipments with video laryngoscope, fiberoptic tools, ultrasound. And what's really advancing is these point of care ultrasound techniques. There is so much that we can do now with ultrasound. Right. We detect lung abnormalities. We can obviously look at the heart with tee and other ultrasound methods there, but we're more readily using ultrasound to look at gastric contents. Now we're using airway ultrasound for an airway evaluation. And then our regional blocs become more and more advanced to as the clarity and the technology within ultrasound gets, gets better and better. And so the case uses for the ultrasound, it is moving towards that sort of new tool that is just going to become more ingrained in this new generation of, of trainees. So those are all examples of how technology is really impacting the training.

Conceptually, there's a concept. It's called uh, CBME - competency based medical education. It's the concept that that people finish their training when they can show that they can do all the aspects of the job, regardless of the amount of time in, in their training. And so this, again, isn't a new idea, but it's taken many years to study it for it to gain traction. And now there's more and more programs sort of acknowledging that using this creates more satisfaction during the training, it builds confidence, uh, and that there's solid results from it. Um, the challenge still remains that actually doing work based assessments and competency based assessments are actually really, really complex. Um, and we're not completely sure--we're getting there--that the process that we use are validated so that they very accurately reflect performance and competency.

Two more topics that came to mind for me for education. One was the idea of fellowships and how they're evolving. I would say in the last 5 to 10 years, the sheer amount of fellowships in perioperative medicine has just blossomed. And there's more and more of these non-traditional ACGME fellowships, and they're popping up in sort of outside the box areas, too. There's a fellowship on the management side, the management of perioperative services. There are some on informatics and media, uh, advanced research methods. And then there are some that are completely dedicated to innovation or entrepreneurship. And so it's these fellowships that really allow the opportunities for trainees within our field to go out and explore and be innovative.

And then the the final area I want to talk about was was about the focus on on wellness. And while that's not a crazy innovative concept, I think how we're approaching it and prioritizing it is forward thinking. Programs are being sort of being forced to look at this, and they are doing it by adjusting call requirements, being more purposeful with various social events or supportive tools. Some programs have counselors available 24 seven on site and other various supportive, uh, features that are now being added to a residency or a fellowship program. And so the concept of wellness burnout, prevention, mental health, it's important. And I hear that permeating through not just anesthesiologists in the middle of their career, but starting very early with trainees as well.

DR. STRIKER:

Well in all these areas you mentioned. I already see being implemented with resident education, whether it's technology, whether it's wellness simulations. As best I can tell, the current residents are formally being trained using these tools and in these techniques and also these other facets of education are being implemented, things like wellness. And so I think it's already there. I, at least in my experience, the current trainees are already benefiting from a lot of these evolutions.

Well, let's quickly talk about the third facet of innovation that you mentioned, practice management. What are some major shifts that you foresee happening?

DR. YE:

Yeah, this is probably one of the most challenging areas. And it is this space that I that I work in the most. So in order to think about how we can innovate in this area and what innovations exist, we first have to talk about the challenges. We've got a major workforce shortage, you know, in the setting of increased anesthesia demand, especially in out of OR sites now. We've got decreased reimbursement by payers at the same time that wages and inflation go up. The traditional hospitals are all sort of struggling, profitable surgeries go to the ambulatory setting. And then internally within our specialty, you know, we've got complicated policies and relationships within the care team model and how we sort of design our anesthesia practices.

Hitting on some of those, first, the staffing issue. I won't speak too much on this. The ASA's got a task group working on this. There's a center for anesthesia Workforce Studies that's got a lot of good resources for people who are interested to go check out. But at the end of the day, it's all about increasing supply. So, you know what are the the most innovative ideas out there? You make training easier and faster somehow without compromising quality, you know, how do you do that? We talked a little bit about that in the education piece. Maybe expanding the various roles within our team or who is on that team. So, you know, right now they're, you know, CRNAs, AAs, physicians – that’s sort of the traditional team. But who else can help? Are there, you know, specialized nurses, do we use some of these moderate sedation nurses and they're considered part of the anesthesia team? Are there things that are anesthesia techs can do as we try to sort of find the right responsibilities for the right member of the team? So the innovations are thinking about how that care team is run, but it's challenging. There are all kinds of care team models. And across the country there is quite a bit of debate on exactly which one works. So, is an innovation medical supervision with higher rates? Can a version of that be improved with telemedicine and the other technology we use? Is that sort of control tower method a way to manage your team? I don't know, these are debatable things, but I would say that, um, we should continue to experiment. Things are going to evolve one way or another. We have to help direct that and be the ones to come up with those ideas and measure which ones work the best.

That's definitely an area that we think a lot about in how to manage our practice. The other, well, it's it's not only about increasing the supply. We maintain our workforce by preventing them from leaving. And the best way to do that is innovative ways to, uh, help with their well-being so that the turnover is reduced. Right. How do we increase job satisfaction, decrease resentment, reduce the fatigue, keep people from burning out, have them stay in the workforce longer. They are now, you know, wellness checks, some groups periodically do stay interviews, focus groups, listening sessions. There's more employee assistance programs recognizing that, you know, behavioral and mental health is critically important and increasing the access to that kind of stuff. Uh, finally, you know, what is time away from work look like? How much of that should we get? And so I think taking care of the provider is another element within practice management.

And then sort of my final comment on this is there's a ton to talk about, but the one I wanted to mention is a big part of my job. And I think within our specialty is the innovation around conveying the value of anesthesia. We know we're important, we know we're valuable. And I think in some cases, we can try to do a good job of explaining that value to our patients, you know, the surgeon and the hospital. But I think we need to do more because I think that value is often overlooked. It's hard to measure. We have to be more active on that. And then one of the ways we're doing it, and again, I'm just echoing a little bit of the message of the ASA is that there's got to be a bigger role of of leadership in these facilities, and we've got to expand our roles and responsibilities within the hospital. One concept that I think is, is interesting to think about, maybe we should do more and more is the concept that a member of the anesthesia team also serves as the OR director or as a leader within sort of the OR leadership team, maybe surgery scheduling where they are in charge of that as well, uh, more active roles in helping to manage the entire OR. We run the board. We've been doing that for decades. But what are the steps beyond that? Uh, and so there are definitely a couple of places where anesthesiologists serve in these much more sort of advanced or related, uh, operational roles. And it seems to be working really well. I think that's a synergy of all the things that we know and how we can, you know, coordinate care and use all of our all of our talents, particularly with better data, the AI based tools, anesthesiologists, we are we're well positioned to sort of be the ultimate leader in the OR. So I think they will continue to be a shift here. And I think that we'll continue to expand our roles into sort of broader OR management and care coordination.

DR. STRIKER:

Well, you certainly brought up some very large topics. We've covered a number of these on the podcast, and I know the ASA is tackling a number of these as well as you, as you've already stated, certainly a lot of big issues there that we are, um, navigating as a specialty. But there's one specific point you brought up that I do want to follow up on, which is the idea of retaining physicians, at least on the latter part of the career where physicians may be considering retiring. Things are continuing to evolve so quickly. You talked about how important it is that we don't let physicians get burned out, and we'd like to have them keep working and and whatnot. But as things evolve and change, as practice changes come, there's a lot of these innovations come through that you have alluded to. What advice do you have for those in the anesthesia community who might be saying, you know what, this is just too much for me. I didn't practice this way. I don't need this. I'm done. You know, it's just too much. How do you reconcile those two issues?

DR. YE:

There are a lot of professionals out there who can gut it out and believe that because of the nature of who we are, we feel responsible and we feel like this is our job and there's nothing we can't do. It's our responsibility to take care of the patient and to be there and to get that case done. I think that's a source of pride for us as a specialty and within our profession. So. So that should never go away. However, I think by sort of having that mentality, it also puts a lot of us in these situations where, trying to do all those things comes at the cost of our own personal life and our own sort of mental health or overall wellness that then forces us to make a decision to to say, let's throw it all in.

So my best advice to those people and the managers of those people is, it's got to be an awareness of the balance that is needed. Very often I will have providers who will overwork themselves because they think it's their duty, or because they're making money for the work that they do. Right. And they keep going, going, going until one day it's just a wall. So that's an example of where you're not sort of really thinking about how you're staying balanced in all that. It’s okay to do a little less or to make a little less. I'd say the younger physicians are a lot better about this than I think a lot of our group. This awareness and this, this actual attention to where you are in your career and what you want to do. Figure out what the balance is and try to achieve it.

DR. STRIKER:

Well, one last question before I let you go. Are you are you optimistic or pessimistic on the future of anesthesiology? Let's just say even 10 or 20 years in the future.

DR. YE:

Yeah, I've got to be optimistic, right? Like I'm I'm going to make an assumption that we as a specialty get a lot of it right in ten, 20, even 50 years. I think we've we keep moving in the positive direction. I think it's been, you know, historically evidenced in how we evolve, uh, we anesthesiologists as a group, we sort of naturally invent and innovate, and we, we just evolve to take care of our patients. It's sort of in our nature. So I think there's a lot of creative people in our community. I think there's a lot of driven people, the ingenuity of us as physicians and just all-around cool people and brilliant thinkers that with technology, all that brings me a lot, a lot of hope. So I think we're going to move in the right direction there.

DR. STRIKER:

Wonderful. Well, that's a great note to leave it on. Dr. Ye, thanks for joining us and sharing your insights into all sorts of potential innovations and evolutions on the horizon for our specialty. And thanks for all your work on the ASA Committee on Innovation and looking forward to just seeing seeing what happens.

DR. YE:

Well thank you. It's been an absolute pleasure to to chat about this topic.

DR. STRIKER:

Well, and to our listeners, thank you so much for tuning in to this episode of Central Line. Please don't hesitate to tell your friends and colleagues about the podcast if you find it useful. If you enjoy it and go ahead and leave a review on your favorite podcast platform. And don't forget to tune in again next time. Take care.

VOICE OVER:

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