Transforming Healthcare Through Community Empowerment (ft. Dr Manish Kohli)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation challenges and opportunities across healthcare and life sciences. And now, your host, Ed Marx. Hey everyone, welcome to another edition of Digital Voices. I have Dr. Manish Kohli with me. Manish, welcome to Digital Voices.

Hey, thank you, Ed. Good to be on the show with you.

Yeah, this is awesome. And the reason we're doing it— many reasons, but one reason is we had you on Ed Talks. So, that's one of our playlists on the YouTube Marx Advisory channel. It's episode 116. So, if you love what you're going to hear on this podcast, which you will, you can also go in the show notes and you'll find a link to that Ed Talks, which again is part of our YouTube channel. And so, we first met as part of Cleveland Clinic. So we both served at Cleveland Clinic and then also at HIMSS, given your prolific role in leadership at HIMSS through the years. So we've known each other on multiple levels, and we'll unpack that a little bit later on. But Manish, the most important question I have for our entire time together is what song is on your playlist? Like, what kind of music does Manish like to listen to?

Oh my gosh, Ed, yeah, that's a loaded question because I like variety. And you know, it, it, a lot of this depends upon the mood. You know, when you look at my playlist, you'll see Western classical here, you'll see Hindustani classical, you'll see Beatles, songs from the '70s and '80s. I'm a product of the '80s. And obviously retro and modern Bollywood. And lately, I've started enjoying listening to music that's not in my native languages.

Interesting.

And just listening to the notes and the emotions they convey. And I find that in many ways quite soothing.

Yeah, yeah, you've made me think, you know, because your natural reaction would be to turn on some different music because you don't understand it. But in some ways it's kind of better because then you're more in touch with the music. Yeah, I love it. I will try some of that. What about life message or mantra? Are there words that you live by or quotes that inspire you?

Yeah, you know, be kind, be present, and really do what you can to leave the world a better place than you found it. So if each one of us does something every day that accomplishes that, imagine what kind of a world we would live in, live in and leave behind.

You know, I think we may have touched on that on the Ed Talks, but, you know, your whole philosophy about being kind, being present, and leaving the world in a better place, where do you think that came from?

You know, as long as I can remember, right? I think it's just who I am. And I think along the ways you have life experiences that validate that and that tell you what resonates with you, doesn't resonate with you. And what I've realized is that if you do something that's connected to your values and your purpose, and that is with the right intention to help, you're on the right path.

Yeah.

You know, the direction might go north, south, east, west, right? That's oftentimes not in our control. But directionally, if we are moving in that right direction, then, then it's the celebration of life, right? The circuitous path that we all take to get from point A to point B.

Yeah, yeah, that's good. So before we get into sort of the healthcare career and what you're doing at Pool Alliance, tell us a little bit about yourself. Like, what's your story? Where did you grow up? You know, that sort of thing.

Yeah, it's so, uh, you know, I was born in India, and like you, I moved to the US when I was very young. You were 10, I believe, and I was 12. And I started high school in Chicago, was the youngest student in my class. So not only did I Have the opportunity and the challenge to adjust to a new culture, new school. I was the smallest kid in my class just because of my age, you know. And and and and when I look in hindsight, right, while I had a lot of friends and stuff, you know, there are probably certain situations that resemble what we call bullying now. But but overall, high school was a fantastic experience for me because I was assimilating a lot of things and was still young. 12 years of age that I could actually, you know, adapt quite easily. And then I graduated at 16. I was a class valedictorian and I was honored to receive the Ronald W. Reagan Scholarship at President Reagan's alma mater in Eureka, Illinois. And that scholarship was for students who show potential in service, leadership, and scholarship. And so that was an experience to go through that.

Yeah.

And then to be part of an ecosystem that not only gave you a world-class education, liberal arts education, which I really value, but small-town America experience. And I think in many ways it shaped who I am. But then I think the opportunity to work with mentors in the field, public health and medicine for me. Then obviously the capstone experience was being invited to the White House and meet President Reagan himself.

Wow.

And, and so, you know, you know, by the time I graduated from college, I had some amazing, amazing experiences, amazing mentors, and I felt quite blessed to be in that position. And obviously, you know, at 20, you know, you have a whole life ahead of you. And so I wanted to be a doctor. I was accepted to medical school. And this was the first time that I actually had a setback in my life.

Tell us.

I had to turn down my acceptance to medical school because I could not afford medical school.

Wow.

You know, and that was painful.

Yeah.

And, but I was determined and I said, you know what, there's probably something better. So I actually worked in industry. I saved up money and I reapplied to medical school and was accepted. And I remember the day I got the letter, you know, the joy I felt, I don't think I've ever felt in my life where it's like, you know, life gave you adversity, but you actually stood up to it and made something out of it. And then med school was amazing. It's an amazing, amazing journey. I went to SIU School of Medicine in Springfield, Illinois. As a first-year medical student, I actually founded a magazine called Scope, a literary and fine arts magazine that publishes prose, poetry, and artwork by medical students and faculty. We got a grant of a couple thousand dollars, and that was the budget that the dean gave us. I think they are in their 29th year of publication.

Wow.

And every year I receive a copy in the mail. You know, it's like seeing your little kid. It's amazing. So, so yeah, I mean, I, and I had leadership positions in med school. I was the class chair for 4 years, and, and then I chose family medicine as a profession because of my experiences in undergrad in public health and then discovering myself through training what I wanted to do. So I did family medicine training. I was chief resident at Rush Hospital. And one other thing that shaped me was actually something that happened— another thing that happened in the first year of medical school. One of my mentors said, there's an opportunity for you to spend Christmas at a refugee village in the Yucatan Peninsula of Mexico. And he was able to get me a scholarship. And I went for 2 weeks as an idealistic medical student, and I came back a humbled man.

Wow.

What I realized was that we can take all the medicines, we can take all the doctors, the nurses, but unless we leave something behind in the communities, we really do little good, and in some cases harm. The best thing we did in that instance was leave— left a book, a couple of books in Spanish called Where There's No Doctor, so these folks could help themselves. And when I look at how that has translated into what I'm doing today, and we'll talk about that in a second. It's really in the digital age, we have real-time connections with these communities. Everybody has a mobile phone. So for, you know, so when I look at the turning point, right, that 2 weeks in some ways was fueling a lot of what I'm doing today.

Yeah.

So fast forward into residency again, had a great time, had amazing mentors, served as chief resident, got involved in looking at improving patient satisfaction and experience and throughput. And I have a computer science background from undergrad, so I was like, where's technology in this?

Yeah.

And so that was sort of the beginnings. And as chief resident, one of the perks we got was a PalmPilot. Now I'm showing my age. And so, you know, so the digitization of healthcare, you know, I go back where we struggled with paper records and I was beginning to understand that it's about transforming medicine and then thinking about digital technologies. That led to my career at Hopkins. I applied for preventive medicine fellowship and I was accepted. And that's where I really began my formal public health training and had some fantastic experiences leading large-scale initiatives, being part of initiatives that involved improving patient safety, quality, public health through technology. One of them was a Rockefeller Foundation-funded project in India, looking at how decision support technology could actually improve access to care in villages in southern India. So we actually looked at the validity of the software that was created, but also user adoption at the community level, at the leadership level, at the physician level. And my God, we learned a lot. But that was also the age, right, when the Institute of Medicine had come out with this report, To Err Is Human: The Quality Chasm. So for me, improving patient safety and quality sort of became the life mantra, especially professionally.

Yeah.

And technology became the tool which I would end up, you know, championing to drive that in organizations. And obviously, I was then selected to be the CMIO for Johns Hopkins Community Physicians, led their digital transformation initiative. We actually were one of the early pioneers of e-prescribing, and then I was tasked with migrating that to an EMR. And, you know, 25 years ago, you know, and you know it from both sides, right? There are a lot of promises made before the contract is signed. Once it's signed, data exchange, how did that happen? And so, I had to sit down and actually help do data mapping and migration of data from one system to the other. But the thing was, right, we delivered on the promise to our physician group. And one of the things that I still feel very humbled and proud is, you know, When we finished the implementation, we had the physician retreat and I walked in and the entire physician body, my colleagues stood up and gave me a standing ovation. And I was just so humbled and drawn to tears in that moment. So, for me, that accolade is unmatched, you know, to be recognized by peers for something that you put your heart and soul into. So, and that led to my opportunity to move to the Middle East with Partners Harvard in Dubai Healthcare City, where we helped set up a health information exchange and did a number of cool things despite the financial markets globally tanking.

Yeah.

And then Cleveland Clinic came along and said that we have a hole in the ground and we have a blueprint and we are looking for the first physician to hire. And I love kind of pioneering things and the rest is history.

Yeah.

Wow.

Now you said so much there. I could dive deep into many of those different areas, but then I don't want to lose our time to talk about Pool Alliance. But it's very fascinating and all the things that you've pioneered. I just, I have to ask one question really quick though. Do you have a picture of you in the White House with Ronald Reagan?

I do.

Yeah, I would love to see that. Maybe we'll throw that up as the thumbnail or something for the podcast. That's pretty cool. No, your whole— and you can see interwoven in everything that you're sharing, this whole philosophy of yours that you shared in the beginning about service to others and connecting the values to what you do. And yeah, it's very, very inspiring. So, Yeah, let's fast forward a little bit. Let's just talk for a second, for those who don't know, just on the Hims part, and then we're gonna jump into Polar Lions. So yeah, so while you're building this tremendous career, you're also helping Hims mature. Tell us a little bit about some of the things that you did at Hims.

Sure. Yeah, I got engaged with Hims as a member, like all of us did. And you know what? While the world gives us a lot of credit for what we have done, we are really a sum of all the relationships we have.

Yeah.

We work in a community, right? And HIMS is such a fantastic community. So, I started out as a volunteer. I was part of the Governing Council in the Middle East, and then I joined the Asia-Pac Governing Council, and then I was nominated to be on the Global Board. And my God, such amazing people.

Yeah.

I mean, they really inspire you, and that really is the feeling, right? You feel like you're part of something special.

Yeah. For sure.

And you learn so much from them. And so for me, it was a different lens into a professional career that I was very proud of. And looking at a member-based society, how do we create member value? What's working in different parts of the world? What's not working? How do we take lessons and learn from each other? Because everybody's struggling with the same challenges. Quality of care, cost of care, access to care. And nobody's got it right. Technology is a promise that everybody sees, but you and I know that we still have a ways to go, you know, to realize the full potential. So being elected the chairman of board of HIMSS was one of the biggest honors of my life.

Right.

And again, to serve in that capacity and to learn was absolutely amazing. I also joined HIMSS at a time when there was a leadership transition, and I was part of the committee that actually helped select Oh, very cool. Yeah. And so, again, the fact that my opinion was valued, the chance I had to contribute and to be a part of something that's bigger than me for sure, but all of us, you know, individually. And that's what, you know, HIMSS represents to me, a very special place. It's the home that we have, that we come together, we connect. We connected there, we connected multiple places, right? But this is how relationships begin. And this is how problems in our day-to-day professional lives, even personal lives, right? We forge friendships, but then global problems, right? We address them in these kinds of forums.

Yeah.

So it's been a fantastic journey.

Yeah, no, I appreciate it. I'm the benefactor of many of the decisions and things that you've done in your career so far. You're not done. You've got a long ways to go. But you also did a pivot of sorts, although you're always wired this way, but you created Or part of the Pool Alliance. So tell us about the Pool Alliance. We've been sort of foreshadowing the Pool Alliance a couple of times, but now we're ready to jump in. Yeah, tell us about this company.

You know, I think in every stage of my career that this is the capstone experience. And then the next thing comes, and I say, no, this is the capstone experience. The reality is, right, everything is sort of teaching you something to do something bigger. And, you know, so when I was at Hopkins, right, I thought my technology training, my clinical training, my leadership training, Is the capstone experience? It was for to be a CMIO, right? But then, having been a serial CMIO, I thought that HIMSS would be the capstone. And then the pandemic struck. And fortunately, I was also on the board of an organization called Wings of Hope, which has been nominated twice for the Nobel Peace Prize. And for the last 80 years, they've been taking donated aircraft and purposing them for humanitarian efforts. So the question I was asked. of a CMIO was, we need help collecting data. What technology can you recommend to collect data? Well, that question is probably not phrased the right way. And so that led to many, many more conversations and discussions, but that realization that we are really doing the last mile a disservice, especially in low-resource settings. You and I know, right, the large organizations, and we have teams that lead various functions, including digital transformation. What's happening in these communities is somebody will give a spare computer they have sitting or some software, right? And maybe some money, maybe a training, and then it's good luck, figure it out. We don't do that to our top-performing physicians in Cleveland Clinic or Mayo Clinic or whichever organization.

Right.

And here you have people who are oversubscribed, overstretched, and it's unfair to expect, right? And so the realization was, that the CMIO type of skillset and the broadly technology skillset that we bring to our organization could be beneficial to these organizations. How do we create scale around that? And then I looked back to my first year of medical school, said, this is an opportunity.

Yeah.

We can connect the community then. And during the pandemic, one thing happened, people started welcoming telemedicine. It was not something that people were afraid of, even though technology had existed for 15 years, 20 years prior to that. So then we said, how do we actually begin to create that opportunity where we bring in people with skillset, volunteers, contractors, vendors, suppliers, and simplify the transformation for these organizations? And that's how Pull Alliance began, where, you know, I started talking to my colleagues, many of them at HIMSS. And I said, what do you guys think about that? And everybody was like, oh my gosh, yeah, I would love to do that, right? And the more I heard of that, the more I said, this is what I have to do. And so that's where we are. We have about 50 volunteers. And I have to tell you, we kicked off our first initiative in Kenya.

Wow.

We are actually going to do something amazing. We are working with the hospital. And again, 1,000 Points of Light, amazing work folks are doing on the front lines facing a lot of friction. A very talented surgeon wanted to do something for women who develop fistula because of substandard care, lack of timely care, and bad sociocultural things that happen to women.

Yeah.

They've been doing it for 10 years, but when you look at what they have to do, what needs to be done, it has a lot of gaps in it.

Yeah.

So we are working with them on strengthening their surgical program, helping them get the right equipment, helping them get the right digital backbone. making sure they have a good supply chain system in place so that they never run out of critical things that they need— medicines and sutures and other things. One other thing this organization does, it takes some of their patients and it actually trains them to be employable, whether it's sewing handbags or whether it's actually working in the hospital.

Yeah.

So we have taken a cohort of 10 women who were former patients, are living in the villages, and we are actually going to invest in them and make them digitally trained community health workers.

Wow.

And they'll be given a smart backpack kit, and they're going to go door-to-door in the villages, actually provide primary care and prenatal care with a smartphone. Connectivity is not an issue that has integrated telemedicine.

Nice.

So anytime they have a question, so first step is algorithms are driving the care. If there's any concern, they're able to reach a nurse or a physician so that we can actually manage patients more appropriately. Concurrently, we are working with a partner that actually can provide eICU as a service. If you're running a surgical program, you need ICU care, right? If you have a mother-baby program, you need a NICU.

Yeah.

If we went the old way saying that let's go ahead and hire critical care docs and build an ICU, that may never happen because it'll be hard for us to get all the resources and the economics, frankly speaking, won't be there.

Yeah.

But now you get a partner that is doing amazing work. They're managing 2,000 hospital beds for $50 an occupied bed a day.

Wow.

ICU care.

Wow.

We can mobilize an ICU within 6 to 9 months. So we're going to give them 2 ICU beds to start with. And that's the start of our journey of transformation with them where we help them with this lift, but then we stay with them. So the central part of this is a buddy program, a mentorship program. Where Ed Marx, the CIO, is working with their IT person and having weekly or monthly mentorship meetings so that this person is able to, in the front lines, say, I've got this problem, what do I do? And over time, you're actually giving this organization and this individual a lot more resilience to fend for themselves.

Yeah.

So that's the model, right? Because it's much easier for me to come and say, Ed, can you give 2 hours a week mentoring somebody? You say, yeah, sure. If I say, Ed, can you go for 2 weeks to Kenya? You say, um, you know.

Right.

So imagine, Himsa has how many members? 100,000 members?

Yeah.

If we ask everybody to give 1 hour a week, that's 100,000 hours of really, really talented people.

Yeah.

That now can be purposed for villages.

Yeah. What I, what I love, and it goes back to your aha moment back in Mexico as a first-year resident and Realizing that just doing a one-time thing, while noble sounding, often isn't that effective. You know, I had that experience. We did missionary work in, with, when I was with Texas Health, we opened up a clinic, which still runs today because we did it in a similar fashion you're describing. And we saw while we were building the clinic, previous attempts at building clinics that were one-off, you know, someone's going to come there for a month and then leave and never have anything to do again. But we knew that wouldn't work. So it has to be something sustainable. And what you all are doing and created is something super sustainable because you're getting local people involved and you're not only providing clinical care, but you're really providing community care, you know, with reskilling of individuals and having them learn and take care of themselves. It's just wonderful. So hopefully many listening are inspired. And like you said, the easy example, like 100,000 members, 1 hour a week. How can people get involved with the Pull Alliance?

Well, they can drop me an email or they can go to our website and just drop a note, and we will find a way to connect with you and get you engaged. We have more need than we have resources. So we are right now, you know, in the process of raising funds to support these great initiatives. And one of the things we are really, really proud that we are doing is, as we upskill these people, we want to create employment opportunities locally. So the money that we raise goes in the communities. So the idea is to create generational upliftment. So we have mentors coming in, we have benefactors who want to give either funds or supplies or equipment. And really the success story is in the long run, these women are able to give their children education.

Yeah.

They're able to pay $50 a year to buy health insurance so they never have to have complication because of delayed care.

Yeah.

So it's really, we're doing a small part in getting this wheel moving. And we want to get all kinds of entrepreneurs to get involved with this. I'll give you an example. Some of these women are learning how to make handbags. I walked into the workshop and talked to a woman who was 24 years old. I asked her, well, tell me about yourself. She said, I'm a fashion designer. This is what empowerment looks like.

Yeah, love it.

I need money to buy a sewing machine and I want to go back to my village and want to put my 4-year-old daughter to school.

Yeah.

Now imagine if we can get a social entrepreneur who works with this woman to be a small business owner.

Yeah.

It's a different skill set than you and I have, right? But somebody probably has that skill set that could be purposed. And we get somebody who is really good in logistics and digital marketing and can put these handbags on a global marketplace.

Yeah. Love it.

So I think in terms of community development, there's just a huge amount of opportunity.

Yeah. And Manish, is there— it's been a while since I've been on the website. Is there a way for families to be involved? So if I'm listening and I not only want to contribute, maybe I'll contribute financially, but maybe there's a way to be involved on the ground in a project and somehow families are incorporated.

Yeah, no, no, we're open to having a conversation because a lot of this is, you know, if we understand, you know, what would be meaningful to the benefactor, whether it's giving out their time or money, and we have the right project, we create the right fit. Yeah.

Yeah. Because I, we do that with our kids. That's why I asked the question. And so we try to incorporate them. in these sort of things. So they had that experience and had that aha moment like you did early in your career, because it really gives you a better perspective for life. And, and then it engages you right on a, I don't know, I call it a spiritual level to make you like see the needs and want to help be part of a solution to help other people that maybe weren't born as in a fortunate situation as you are, you or I are. This is amazing. I'll definitely put the information in the show notes for people listening. So let's pivot. A little bit into leadership. Was there anything that happened early in your life that prepared you for— I mean, you're an amazing leader, all these different roles you were describing. Like, when you look back, were there some early childhood things that may have helped shape you?

You know, I think some of this is innate. Some of this is your family values.

Yeah.

But I can tell you, when I moved to the US and started high school, a whole world of opportunities opened up to me.

Yeah.

I mean, our country is amazing, right? I mean, we really, really are blessed to call ourselves Americans. And in high school, I had a chance to be part of Junior Achievement. That was part of one of the first formal things. And what I did was we published an insert in the Chicago Tribune, and my job was to sell ads. So I actually went door-to-door selling ads and there were some small business people. I remember one was the 60 Minutes Photoshop. Remember, you know, when we had those films and we had to take them to these 1-hour photo shops?

Yes.

I went to this woman and she herself was a Junior Achievement graduate and I talked to her for 2 hours. But the fact that I actually was able to sell an ad gave me so much confidence. I mean, it's amazing how at that age small things can actually have a huge impact. I also mentioned the Reagan Scholarship that connected me with mentors and helped me see what leadership looked like. And obviously President Reagan, you know, when you're at his alma mater, you learn about his journey and kind of a blueprint. And obviously our Reagan Scholarship program had a lot of formal programs that talked about leadership. So I think there was a culmination of a number of things, but I think that something inside that said that you got to do something that's bigger than yourself.

Yeah. No, I love it. Manish, we covered so much. And like I said earlier, I want to keep going. There's so much more to unpack about you and lessons that we can all learn from you. But we did cover a lot of ground. Everything from music and the idea of listening to something other than your native language. I love that. And then we talked about sort of what drives you, your mission focus and how you grew up and how all these things came together to develop You and how you took— I love the story too, how you took sort of a negative setback, you know, when you couldn't afford to go to medical school. A lot of people may have given up on their dream, but you still kept that dream alive and eventually were able to get back into it. So it was really about perseverance. And the great work of Pull Alliance is pretty amazing. Is there anything we missed or anything you want to double down on? I'll give you the last word.

You know, I love to travel, Ed, and you love to travel as well. I've traveled to 63 countries.

Wow.

And I love culture and I love food. You know, over the years I've become more vegetarian, so my choices sometimes get limited. But I get really fascinated with the role culture plays in how we approach life and problem solving. And one of the things I've noticed as I've traveled from the Middle East to Western China, Central Asia, to the Far East, is how spice routes developed. and how culture developed along the way, right? So I'm a forever student of understanding how humanity has evolved. One of the most interesting stories I had was when I was in Central Asia, in Uzbekistan, and I was visiting one of the cities on the Silk Route and started talking about, you know, Uzbeki culture. And there are a lot of similar elements to Indian culture and Middle Eastern culture.

Yeah.

And one of the things they said, that guest is God. in those cultures, right?

Yeah.

And they explained to me why that came to be. The silk merchants were the source of livelihood for people in the villages. They used to bring in goods that people could buy and sell. They used to buy things from them. So you wanted to treat this person who was the source of your livelihood like God.

Yeah.

And, and that was the origin of that. And, and then when, as I sort of partaking some of the food, right, you realize some of the similarities in food. But not only that, music and dance. So, so for me, that's become a forever fun thing to do as part of my professional and personal travels.

Yeah, that would be fun to trace all those routes. I've seen some documentary on that before. That would be like super fascinating. Wow, this has been tremendous, Manish. I appreciate you being a guest on Digital Voices.

Thank you, Ed. And you know what, since you've been an author and since we're talking about spices, maybe we should write a cookbook. Or a spice book and, and tracing the, the trade routes.

Yeah, we could be the Spice Boys.

That's— I love it.

It happened here. You heard it first.

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