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The third episode of Moffitt Cancer Center's Cancer in our Community podcast focuses on digital health and features Chief Digital Officer Dr. Edmondo Robinson. Tune in to hear from our experts working to create health equity. 

Welcome back to Cancer in our Community, a podcast brought to you by the Office of Community Outreach, Engagement and Equity at Moffitt Cancer Center and made possible by a generous gift from Dr. Michael Vogelbaum and Ms. Judith Rosman via the TOP Jewish Foundation.

Dr. Blue: Hello, and welcome to another episode of Cancer in our Community where we're having conversations about Black health equity. My name is Dr. Brandon Blue. I'm an oncologist here at Moffitt Cancer Center in the Department of Malignant Hematology. And I'm your podcast host today.

We're excited to speak with someone whose work may be a little bit more unconventional at a cancer research center, but join us in welcoming Dr. Edmondo Robinson.

So Edmondo how are you?

Dr. Robinson: I'm doing well. Thank you for having me, Brandon.

Dr. Blue: We're happy to have you here on our podcast.

Before we get into our question and answer section. I'd like to give you a little introduction to Edmondo's background. Dr. Robinson got his medical degree from the University of California, Los Angeles, UCLA.

An MBA with an emphasis on healthcare management, from the Wharton School at the University of Pennsylvania and a master's degree in health policy research also from the University of Pennsylvania. He now leads Moffitt's Center for Digital Health, which leverages the tools of IT, health data services, and digital innovation.

Let's start with an easy question. The Center for Digital Health. What is that?

Dr. Robinson: So the Center for Digital Health is really an organizational principle around how to, how to build digital as a core competency in your organization. So there are different ways you could think about digital because digital is really broad. What does digital even mean?

But for us at Moffitt, it means that we're going to look at these core assets that we have information technology.

Right, your core IT systems, whenever someone thinks of IT, that's part of our center for digital health, but also data. Data is a really important asset and we have to figure out how to incorporate that into our overall concept of digital.

And then the innovation piece. How do you build the future? How do you build the future of technology? How do you build the future of interactions with our patients? How do you build the future of even our business operations? So again, technology and IT data and health data services in the innovation piece, you bring them together and that is your true digital asset that allows us to accelerate our mission to prevent.

Dr. Blue: I'm glad you broke that down because I really had no idea what you did, but now that makes a lot more sense. One question that I have is, are we the first cancer center to do this? Or has this model been done at other places?

Dr. Robinson: So we're not the first cancer center to create this model this way, but the number of institutions cancer or otherwise that have this model, I can count on one hand.

So it's increasing. As a model for how to deploy digital, but it's, we're very early. We're very front frontline in terms of thinking of it this way. One way to think about it is digital is your strategy and the technology and the data and the innovation are how you execute that strategy. So my job as a chief digital officer is to articulate the strategy and my team's job is to execute that.

Dr. Blue: So we use a lot of words that some of our listeners might not be as familiar with. Okay. One of the abbreviations that we commonly hear when they say something is digital, is AI. Now I am an old-school basketball guru. So AI for me means Allen Iverson. Okay. But I would imagine in the digital field, that means something else. So when people say AI, can you kind of break that down and kind of what those terms really mean?

Dr. Robinson: So AI, what, what we see, let's say you're watching movies and all that, and you see these robots, right? Like I, robot, Will Smith and all that, you know? So you're thinking of these, these robots that are essentially almost as intelligent as human beings, but they're, but they're machines. That's not what it is. And I, I just want to be clear. So we're not talking about intelligent robots running around, running around Moffitt, but the concept you're, you're heading towards the concept, which is you're trying to build machines that can replicate some aspects of how a human being thinks.

Now we're not there to be able to replicate all their aspects, but some aspects of how he may be might think and be able to do that really well. So that's generally what artificial intelligence is. It literally is that thing it's artificial, but it is intelligence. Right? So now how do we think about that in terms of what we do every day?
Essentially? The main way we use artificial intelligence is by building what we call an algorithm. So it's basically a program or an equation that allows us to predict what the future's going to be. So you build an equation that says based on all that I know about the past, I can tell you what the future is going to be.

So you think about the weather, right? How do the weathermen and weather people know how to predict what the weather's going to be, is because they use models based on what's happened in the past. What's going on right now to tell you what they think is going to happen in the future. That's why it's not a hundred percent. Right, but it's pretty close because they've used a lot of data from the past.

That is a similar concept. We're now going to say, how do I predict if a patient's going to get sick, I'm going to look at all previous patients that were similar to this, this patient. I'm going to understand where this patient is now. And I'm going to be able to predict and tell you whether or not this patient is going to get sick in the future.

Dr. Blue: So there are some interesting questions. So right now we're in the age of what they call personalized medicine. And there's a big push for me as an individual patient to actually get treated differently than the person with the same diagnosis right next to me.

Right. So how do you use something like an algorithm? But still, deliver personalized medicine.

Dr. Robinson: It's a great question. That's exactly the point is that algorithms again, when you're using AI and machine learning, which is another, another concept, but with a subset of AI, but when you're using AI, what you're allowed to do here is hyper-personalize the approach because you get to, you get to feed in all, everything you know about that particular patient. And that allows the algorithm, the equation, the AI, to predict for that patient. It's not predicting for everybody. It's predicting for you based on what it knows about you and what it knows about everybody else that's come before you.

Dr. Blue: So, what type of information would you guys need for something like an algorithm? Would you need to know, like my dog's name, what kind of pets do I have? Like my grandma's maiden name, the stuff that they put for passwords or like what kind of information would really help an algorithm be successful?

Dr. Robinson: Great question. It's actually not as easy as it might seem. So typically what drives what's clinically important, are things that are clinically important, like, your lab values and your diagnosis and your stage and those kinds of things. That's typically what you need. However, this is the beauty of artificial intelligence.

You don't presuppose what you think is important ahead of time, because the way you build these accurate algorithms and they're very complex, but the way you build them, you allow it to tell you what's most important. So when I, when I do other algorithms before AI, I would just, I would, I would guess what I think is most important.

I'd build a predictive model and I'd see if it worked. The way these artificial intelligence algorithms work is that you give it as much data as you can, and you allow it to sift through and tell you what's most. From a prediction perspective.

Dr. Blue: For the listeners out there, I think it would be helpful because I think a lot of people understand the concept of a medical doctor like myself, right?

A patient comes in sick. They tell me kind of some of the problems I say, oh, this is your issue. And these are some medicines that will get you better. People also understand the research standpoint. Like, hey, there's a question that we don't know, we're going to answer this question and then here's the results.

But like how technology fits into medicine and healthcare. I think we don't really have a good example of that. And so I think it would be helpful to kind of really bring it home to the people and say, this is how technology is actually working in healthcare. And could you give us some examples?

Dr. Robinson: Oh, there's, there's so many. One example would be, I don't know if you've ever ordered a Domino's pizza, but when you order, I am going somewhere with this, by the way.

So when you order Domino's, if you have the app, you can track where your pizza is along with the pizza creation kind of pathway. Imagine you could do the same thing on your own clinical journey, where you can track where you are along that journey on your own. Or you want to know what's going on with your labs. You got your blood drawn, where are your labs, why haven't you gotten the results yet? And you can track that.
So my point is that we're going to take the same concepts that we already know in other industries like retail or like food and dining, and we're going to bring them into healthcare, but you need the technology to do it. You need the underlying process and you need the underlying technology.

So that's one area where we're going to make it the way that you interact with everything else in the world. Uber, Amazon, all of those things we're going to, we're going to reflect that into your healthcare journey. So that's what we call consumer digital. Okay. So that's one aspect of technology.

Another is just what I mentioned, which we call it, which is really around the clinical piece, which is let's predict the future and then treat the patient based on those predictions. So that's what we were talking about with the artificial intelligence algorithms. That's another way where we can directly, we can directly predict some of those, some of those pieces.

Another is research. Can I use machine learning or AI algorithms to predict what I think should be the most promising new innovations in research? Can I actually use artificial intelligence to sift through all the options? And get me to the ones where I think are the most promising: they're going to cure cancer for this, this particular diagnosis.

Right? So you can use AI to do that as well. Another way you can use artificial intelligence or even just digital, just broadly using digital is folks don't think about this as much, but it's really important for us as a nonprofit, which is using digital; something we call robotic process automation, or basically automating things, use digital to make your business operations, your back office, more efficient.

Why is this important for, for, for the folks listening? The more efficient my operation is my business operation. The more, I can take those dollars that I was using to run the business and I can take those to take care of patients and to give to research, right? So you don't want to spend as much money on running the business. You want to, you want to spend that money on research and, and, and taking care of patients because we're a non-profit at the end of the day, that's where our funds should go to drive our mission. So, and that's just, those are just a few examples of where, where digital really is right now.

Improving the way that we take care of patients, the way that we do research and allowing us to accelerate our mission to prevent and cure cancer.

Dr. Blue: I'm glad you brought that aspect in because whenever you see these futuristic AI artificial intelligence or technology movies, it always is sometime in the future, but it sounds like those times actually may be happening right now.

Dr. Robinson: Those times are happening right now.

Dr. Blue: Would you suggest, or could you offer to the listeners any things that you might be excited about that in the next five, maybe 10 years to say this is going to be a kind of a game-changer in that community or in that, in your realm?

Dr. Robinson: I think, I mean, it was your first question that I'm most excited about. It has the most opportunity and potentially some of the challenges as well that we could get to. But you talked about artificial intelligence from the very beginning. I think that my prediction is that artificial intelligence in some way, shape or form is going to be baked into everything we do in healthcare.

Soup to nuts, everything. It's going to be in how we deliver the care. It's going to be how we interact and engage with those that we serve: our patients and their caregivers. It's going to be, and how we run our operations is going to be in how we do our research is going to be in how we educate the next generation of doctors, clinicians, nurses, pharmacists, and so forth.

It's going to be in everything. And there are examples. And there are use cases again that we're doing right now and that we will be doing in the future. Like you said, over the next three to five years, I'd say where that is going to be true. That I'm really excited about because. I think it will accelerate us.

So as you know, with the pandemic, our virtual visits, for example, our telehealth visits exploded. You're doing telehealth visits, right? It's exploded because of the pandemic, these kinds of world-changing events accelerate innovation. I think this is one of those times when innovation is going to really take a big leap forward.

Dr. Blue: Well I will bring this up because with any new innovation comes, the idea that there's going to be maybe a new disparity in some group that gets left behind. So as you know, the main purpose or premise of this podcast is to really talk about the community, about the people that are listening and trying to figure out a way that we can make sure that these inequities are brought about and discussed. You use the word baked in and unfortunately in the healthcare system right now, inequities are baked in. So how do we make sure that as technology and artificial intelligence and all these things are happening, how do we make sure that certain populations of people don't get left behind?

Dr. Robinson: So a really important point and one that is top of mind for me and I will bring it up anytime I get a chance. There are two aspects of your question that I want wanna, I want to dig into one that's more general and then one that's more specific within that. One is broadly speaking digital. I like, like we said digital, digital technology innovations are going to be in, in lots of different places that already are in less different places within, within the healthcare environment ecosystem.

There's this concept though, of the digital divide whereby there's going to be haves and have nots there already are, haves and have nots potentially around some of these digital tools and technology. So you can almost think of digital as another social determinant of health, right? We think about education, you think about transportation, you think about access to fresh fruits and vegetables, things like that, food deserts and I think digital is going to be another one of those social determinants that are going to be really critical for, for health outcomes.

The digital divide basically is, is, is this description of what that difference is, but it's, it's different than say transportation or, or food deserts in that how that's going to be reflected is do you have a device, for example, a smartphone or something like that that actually can engage with digital tools and technology.
Do you have wifi broadband access? Do you even have access to the internet at fast enough speeds that allow you to interact? Do you have what we call, not just health literacy, digital health literacy, right? That's a whole nother concept. So there's, there are multiple concepts of this digital divide, but the underlying premise here is that we have to start to design for, understand, and then design for the possibility that digital will actually widen disparities. But if we do it right, digital could actually shrink disparities. Right? So imagine transportation might be an issue from an access perspective for, for some certain communities. Well, if we get digital, right, we can use virtual care and telehealth to eliminate the transportation disparity. Right. So if we do it right, we actually can address disparities with digital tools. So that's one aspect. I think it's really important that we get it right. And we, and we keep a laser focus on this. The other aspect is specific to artificial intelligence.

I'm concerned about these predictive algorithms being biased. So we've already heard about more in the general, in the lay press, you may have heard about it, this facial recognition, right. But they don't recognize folks with darker skin, or maybe you, maybe you have like a scanning device, but if you have darker skin, it doesn't work. Those kinds of things. Those are out there. And there's AI that's drawn in there. And the reason why they don't work in a lot of cases is that they did not train those models on a diverse enough population. So with the underlying data that's training, the model is not a diverse enough, wide enough, broad enough base, then we're going to, we're going to run into problems from a, from a biased perspective, I do worry about that. And there are tactical ways to approach that. But I think in general, it's not thrown the baby out with the bathwater on AI. I think it's, it's a very powerful tool. We've got to get it right.

Dr. Blue: So one of the main messages that you bring up is getting it right. I actually have heard an interesting story. So the school system had this same problem. They were trying to say: all right, COVID happened, schools are closed. We still need to get information and kids need to learn. So their idea was to let's get everybody, either laptops or iPads. They did that.

And then they found out that up to 30% of the households didn't have WIFI. Right. What they thought was a good solution to this problem, unfortunately, caused an even bigger problem. Okay. So could you talk to maybe some things that either Moffitt is doing, or your department's doing are here in Tampa Bay or some ways that we can say, hey, this is what we know is the issue, but this is how we plan to solve it or help address that.

Dr. Robinson: So one of the ways to approach that, and I have a similar story. Someone was noticing that there were these students, these kids that were always in McDonald's every night, why are they in McDonald's every single night sitting at the table?

That's the only place to get free wifi. And that's why they were there. Right. They didn't have a library close by. There's nowhere else to go. They didn't have Starbucks. Right. So they were in McDonald's. So that is, that is absolutely true from that perspective. So part of what we really want to do to address this in Tampa Bay specifically is to understand what the needs of the community are.

We can't presuppose what their needs are. Let's do the assessment and say, what are, where are the gaps? Know where are the gaps to access, where the gaps are from a digital perspective. And then we have, have very pointed interventions based on what we've identified. Right? So our, our center for outreach, engagement and equity really does a lot of that assessment here at Moffitt Cancer Center, where we look at it and say, well, what are the gaps in the community, engage with the communities directly.

And, I was trained in something called community-based participatory research, where you actually engage with the community in developing your solutions and in developing your research agenda. And then you go in, have very specific interventions to address a, so for example of the wifi, do we, can we work with the city? Can we work with the county? Can we, can we do something around just giving everyone free WiFi. It doesn't just, just put WiFi in the air. Everybody has it. Right? So in certain communities have done this, it's not, it's not unheard of they have done this. They partner with maybe the providers, the digital providers and they've made it just free for everyone.

So those are some of the interventions. Once we identify, I don't want to solve a problem that I haven't identified yet. The problem first and then go in and come up with a solution.

Dr. Blue: One of the ways that, you guys have been really able to identify some of these problems is by really using the data.

You've kind of mentioned that you need data to answer questions. Unfortunately, as of right now we have a big medical mistrust issue, COVID vaccines came out, nobody trusted them. Our community, unfortunately, seems a little bit more vulnerable due to a lot of different issues that we don't have time on this episode of the podcast to really talk about.

But like when we say data, people always feel like, Hey, this is my information. Okay. But what do we have in place to make people feel secure? And of course, the plan is to help them. But how do we know that this won't get leaked? We hear about these data leaks and how do we make people know that, Hey, this is a place that we really try to keep things secure.

And while we may get some of this information, it's really to help you.

Dr. Robinson: This is a very important point. So let's say let's, let's put digital on the side for a second. Let's say you're going into your, to your doc. And you've got to get a blood test, right? They need to check your blood.

Well, those results are somewhere. And the doc needs them to take care of you and you trust that the doc is going to use them appropriately to take care of you. That's why you got your blood tested. Well, that's true of all the data we have about you, not just that blood test you got, right. It's true about the zip code that you live in. It's true about any other financial information we might have for you. It's true about any, anything we know about you. We are, based on a federal mandate, required to keep those data about you safe and secure. We're required to do that. And there are significant and severe penalties. If we don't. Right.
So it's actually part of my team that is called the cyber security office. Right? So I have a chief information security officer that basically it's cyber security. So, now that so much data is digital. We have to have not a Fort Knox, but we have to have a digital Fort Knox to keep your data safe.

And that's what my, that's what my team does. So our goal at Moffitt is to have a world-class cyber security function so that your data is safe. And you know that your data is being used for the reasons that you have approved it to be used in. Not for anything else. It's not getting leaked out. It's not on the dark web. That's what our team does. So part of my team, it's not just like, give me all your data. It's how do I keep your data safe, secure in being used for the things that you've approved.

Dr. Blue: Yeah. I think it's just, people are scared. Right. I'm sure we've all had the scenario where you're talking in a car at your friend's about Domino's pizza, the next thing you know, you look on your phone, there's a Domino's pizza ad.

Dr. Robinson: [laughing] That's right

Dr. Blue: Siri, we have Alexa, all these different devices that are always listening to our conversations.

So people get nervous when you talk about data, so I think talking about cybersecurity and really saying that us having a world-class cyber security office here at Moffitt, I think does give people some type of reassurance because when you talk about very vulnerable situations, such as cancer, such about blood disorders, such about very intimate things that some people don't even share with their families, they need to make sure that this information is not getting out there to the masses.

Dr. Robinson: It's so important. And what's, what's interesting is folks are, are more concerned about it now that many of those data are digital, but I've been practicing long enough that when I started, everything was on paper. And if someone grabbed your physical record, the paper record and walked away with it, I actually had no idea.

I had no idea they could, they could go photocopy it and bring it back. I would have never known it was gone. So your data was at more risk on paper than it is digitally because if you even open if someone even opens your medical record chart in our electronic medical record, I'll know. If you just open it, just look at it. I'll know. Everything is tracked, right? So that's much more secure than the old paper days. So the way that we keep it secure is by having, to your point, a world-class cybersecurity function. But I just want to reassure folks that we are much safer than in the back in the old paper days.

Dr. Blue: Well, we want to wrap up the podcast by really leaving the folks with a take-home message for the listeners so out of all the different areas and the different things that we've discussed today, is there kind of one or two kinds of really take-home messages that you want the listeners to learn about all the interesting things that you do.

Dr. Robinson: We didn't even talk about the fact that I take care of patients in the hospital and all that, and we can leave that on the side, but, I think the one take-home that I want folks to understand is that Moffitt being a world-class cancer center with the clinical care and the research is being supported and advanced by a world-class digital as a, a tool and a technology that helps support and accelerate the clinical and research components of our mission, and the educational components of our mission.

So my point is that you don't just that we have wonderful doctors, we have wonderful researchers, but know that the team that supports them from a technology and digital perspective is just as world-class as the team that actually executes on the research and clinical side.

And I think that's important so that we are bringing in all those innovative tools. If you've seen something we've seen it too. And, and that's, how we, that's how we roll. That's how we work and that's how Moffitt is going to stay the best cancer center.

Dr. Blue: All right. So Edmondo before we get you out of here, one thing that we always want the listeners to know, is that not only are you a great person in the world of AI and digital health, not only are you a world-class physician, yourself. But you're also a human being. So with that being the case, you got to tell the people, what's one fun fact that listeners can know to kind of bring you a little bit of a human feel to Dr. Edmondo Robinson.

Dr. Robinson: I guess I'm not a robot then no, I'll be, I'll be a human for a second. The one thing I'll share with the listeners, I like to drive fast. But I do it in a safe and legal fashion. So what I do is I take my race car on the track and I like to really push myself. I'm not really racing other people per se. So I'm not in a race in that sense. I'm really racing and challenging myself. And pushing my own limits when I'm on that track and I'm coming around that straight away and I've got to make that left turn with a downslope and I can't see the next turn after that.

That is that's challenging myself. Here's what happens when I'm on the track. Nothing else matters. I'm not thinking digital, I'm not thinking, being in the hospital, I'm not thinking what's, Adele's next album's going to be about the only thing I'm focused on is getting that line right.

So anyone, who does drive on tracks, knows there's a line you're supposed to follow. Right. I'm thinking about getting that line, right. Hitting that apex. That's what I'm focused on. And for me, given how broad my day is in my work and all that, I'm thinking about all the time, when I'm on the track, it's like I'm in a whole nother world and that I really am. And so that's, that's what I do. That's what I do for fun.

Dr. Blue: Yeah. I actually may join you, I don't have a race car, but I'll put my minivan out there.

Dr. Robinson: [laughs]

Dr. Blue: and we will make sure that you get some competition. Okay.

Dr. Robinson: We can try that. [laughing]

Dr. Blue: We can try it. I'm ready.

Dr. Robinson: Outstanding.

Dr. Blue: It's really been a great session. This has been an excellent episode that we've literally learned a lot about a lot of the different behind the scene areas of Moffitt that people really haven't been exposed to. We'll make sure that we share some of the links in this episode. Really show some notes for people who want to hear more about the things that you do.

Well, that's all from us. Thank you so much for your time today, Dr. Edmondo Robinson.

Dr. Robinson: Thank you.

If you would like to request an appointment at Moffitt, contact us at 1-888-663-3488 to get started.

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