Episode 18: The Role of Technology in Optimizing Blood Health

"We should think of blood as the body's liquid organ, not just an IV fluid or medicine, and do everything to keep it healthy inside the patient." Sherri Ozawa, Director of Clinical Operations at hc1.

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Episode Spotlight: Boombostic Health with Sherri Ozawa

Join us on Boombostic Health as we delve into the groundbreaking field of patient blood management with Sherri Ozawa, MSN, RN. Her insights are reshaping how we view and handle blood in healthcare, driving both innovation and improved patient outcomes.

Top 3 Insights:

1. Blood as a Liquid Organ: Sherri challenges us to see blood as the body's liquid organ, not merely a fluid or medicine. This shift in perspective is crucial for prioritizing blood health and reducing unnecessary transfusions.

2. Economic and Ethical Implications: By minimizing unnecessary transfusions, we can significantly cut healthcare costs while fulfilling our ethical duty to optimize resources. Sherri's insights highlight the dual benefits of effective blood management.

3. Global Perspectives and Future Vision: Drawing from her work with the World Health Organization, Sherri offers a global view on patient blood management and envisions a future where this approach is a healthcare priority worldwide.

BRADLEY: Hey everyone, Bradley Bostic here. Welcome to the next episode of Boombostic Health. We're on episode 18. And here today I've got Sherri Ozawa, who in full disclosure, we worked together at hc1 where I'm CEO. And also though she is actually at a global level, a thought leader and experts on patient blood management, which as we're unpacking in this series of podcasts here is a massive component that has been up to this point, not really optimized in many cases. In some cases it is, but just quickly on Sherry's background. So she is currently the Director of Clinical Operations and Delivery for comprehensive blood, patient blood management at hc1.

Also a founding member and past president of the society for the advancement of patient blood management. And most interestingly, I think she has all of this expertise that has been built over a couple of decades that also includes what you refer to as bloodless medicine. So that's a function of the environment where the HIV and AIDS epidemic was happening. Transfusions were really difficult in those times. So she learned a lot through that. We're super lucky to have Sherri here today. Luckily, she's not off in Italy speaking on behalf of one of these major organizations or Malaysia, as you recently were with the World Health Organization. Sherri is actually one of only two representatives from the United States on the World Health Organization's working group on patient blood management and she's the only nurse representative. Is that correct? 

SHERRI: Indeed. I have to also give the promo that the other person from the United States also works with us at hc1, Dr. Gross.

BRADLEY:  Dr. Gross… So we have a corner on the market of the World Health Organization, Patient Blood Management, which is something we're really proud of thanks for being here, Sherri. I really appreciate you taking the time.

SHERRI:  Thank you, Brad. So great to be here. I'm so excited to talk about this subject.

BRADLEY:  Cool, so with that said, you could be doing a lot of things with your career and you've been invested here. What inspired you to get into the patient blood management world and just to healthcare in general?

SHERRI:  Yeah, thank you for the opportunity to talk about it. I will go into ancient history because I've been in for a few decades, but started my career really first actually as a musician, made a shift when I had to make a living into healthcare.

BRADLEY:  A musician and what's your tell me about that as a musician? What is your specialty?

SHERRI:  I'm a cellist, actually, a classical cellist. Yeah, I did. I did. I performed. was my actually undergraduate was in music therapy and played professionally. You know, not a superstar, but enough to make a few bucks. But, you know, tough. I wish it were different, but the arts is a hard place to make a living. 

BRADLEY:  That's amazing. So did you perform? Do you still play?

SHERRI:  I kind of do still play. We have some really great places in northern New Jersey, right near New York City, some great community orchestras.

An interesting subject for a different day but lots of medical people, of pieces of the brain I think, lots of physicians and nurses actually in music as well. 

BRADLEY:  That makes sense. Well, you'll have to give us a concert sometime. That'd be fun. I'm sure you're fantastic. Okay. Sorry to interrupt your flow professionally, but just was curious to hear about that. So, carry on.

The HIV Crisis and Its Impact

SHERRI:  I'll bring earplugs too. Thank you. So I made a bit of a career change into nursing, kind of aligned with the music therapy background. And I entered nursing at a very interesting time in history during my student nurse years was really the height, unfortunately, of the HIV crisis now. Thank goodness, right, because of lots of great work, we have lots of therapies that can help patients. At that time in the beginning, there wasn't a lot. So it was a really tough environment. 

BRADLEY:  Yeah, there was nothing. It was a death sentence. I'll never forget the Magic Johnson, you know, special that you got onto network television back when that was the main way that you got media and shared what had happened. And, and at that time you thought, probably, he wouldn't be with us for very long. So thankfully, as you said, due to a lot of breakthroughs that he is here.

SHERRI:  Yeah yeah, absolutely. But in those early days, right, we thought a lot differently about the way we're delivering care and although there were lots of means of transmission of that virus, one of them, as we know, was through blood transfusions and blood components. As a result, right, there was really a very interesting pause all around the world on the use of blood and really a minimization because we were not sure of the safety. Now like that has changed and we're not living in the past, but we did learn from that period of time that people didn't stop getting sick. People didn't stop having babies. People didn't stop having car accidents yet. Somehow we managed to manage these patients with much less and many times no transfusion because it just essentially wasn't available. And in many parts of the world, that's normal practice. 

There's parts of the world where it's just it's just not there, right? Even if people were willing to accept it and it could be that it just doesn't exist. You referred earlier to that term bloodless. That's kind of the origin of that. In addition, there are patients for whom blood is not an option because they don't want to accept it, right? And it was an era of also really recognizing that people, you and I, we have autonomy about what happens to our bodies. So if somebody doesn't want it, they shouldn't have it. And early on in my career then in nursing and then as a critical care nurse, what we started to see was these patients who we thought, well, we don't have blood. 

Traditionally, we transfuse this kind of surgery or this kind of illness. These patients avoid the outcomes that are going to be terrible because we don't have the blood to use. In reality, a lot of times they did just as well and even better than they did when we were traditionally sort of transfusing them. So that made us think there's a whole lot we probably don't know about what we think we've been doing with transfusion. This is an area of science that we actually need to build.

BRADLEY:  So an unexpected consequence of the bloodless phase was you started to actually see what we thought was the standard of care, should be the standard of care, as we were over transfusing, it sounds like, potentially.

SHERRI:  Yeah. And you know, we don't have, again, time to talk about tons of history, but really when you look at the way from a historical, and there's a big economic element to this too, the way that blood entered into our medical system, did not take the traditional route that the things that we put in ourselves or in our patients or on our patients do. We have some concept of regulatory action through it. In the United States, the FDA, and other countries have their vehicles for safety and efficacy, right? In theory, whatever sip you just took or whatever pill I just took this morning, somebody has tested that to make sure that it is safe. What are you sipping?

BRADLEY:  It's Guava Sao Paulo. Now it's naturally essenced. How's that for a marketing term? it's, it's disappearing. It's disappearing with my virtual background, but yeah, anyway, yes. Somebody tested that to see what the contents were so that it wasn't harmful.

 SHERRI:  Right. Exactly. And then if we take it a step further, right, beyond sparkling water into a medication, somebody has said this medication for your high blood pressure or my diabetes or whatever it is, is going to do more good than harm. Right? Everything has side effects. But if the benefit outweighs the risk and patients are informed, we make the choice and we do it. 

Blood did not take that pathway. It never actually went to any regulatory agency to prove safety or efficacy. It entered the medical system during the world wars and that is not in any way to take away from amazing work, right? That people have done scientifically in the military at the frontline and the goal of PBM is not to patient blood management. We'll talk about in a minute is not to say blood should never exist for transfusion. It should go away. It's just really to say we didn't really know what we were doing and as a result, we were overdoing something that we had never really actually tested to be safe and effective.

Exploring Alternatives to Transfusion

BRADLEY:  Well, and I suppose there are multiple different reasons to transfuse. In some cases you've lost a lot of blood, like in that example of an injury in the battlefield. And in other cases though, somebody might have a low level of iron in their blood, for example, like with anemia, is that fair? And that's, and sometimes that's people transfuse for that. But I think if I am understanding your perspective correctly,

 SHERRI:  Exactly. Yeah.

BRADLEY:  Is your view that we should be exploring all different options before transfusing, just like you explore all different options before you do an organ transplant?

SHERRI:  Exactly, Brad. And that's where you really hit the heart of it, is that if we start to have a patient or ourselves have some failure in an organ system, we know probably friends or family that have some level of heart failure or kidney failure, right? Too common, maybe, but what happens with the clinicians who take care of those patients? They don't start to have heart failure and we say, let's transplant immediately because those organs are not readily available and there's a bunch of other things that we need to do first, right? So there may be medication changes. We may tell people how to have a healthy lifestyle, control stress, control blood pressure, all these different things. And then as a last resort, if it's available, right? And if the patient's willing to accept it and all the things line up, we may transplant that organ. 

So if we look at blood, it's sort of almost overly simplistic, but if we think of blood, not like an IV fluid or like a medicine or some substance, we think of it as the body's liquid organ. The first thing we don't jump to is not to replace them. We might eventually get to that point, but we try to do all the other things to essentially keep it inside the patient and keep it healthy or inside us and keep it as healthy as possible in the simplest form and then we mitigate so many risk factors. So for some patients eventually that big battlefield injury, big cancer diagnosis, transfusion may be indicated, but is that the last thing we reach for? and try everything else first to optimize what's already in this patient, this amazing untapped resource.

BRADLEY:  So if I think about skin as an organ and you want to protect your skin, you put on sunscreen or, your kidneys or your liver, other organs where they're helping to get impurities out of, out of your blood. And so in that case, you've got certain dietary things you can do. What is it? What's the equivalent to sunscreen with skin to what your blood is? How should our viewers and listeners think about it?

SHERRI:  Yeah, how do you take care of your blood, how do you make it better?

BRADLEY:  Yeah. Exactly. 

SHERRI:  Yeah, it sounds like we don't really think about it, right? The way you just expressed it, we don't really go to the doctor. A person might go to the doc and say, like to the dermatologist, give me the once over, I'll take a look at my skin. Or we'll go to the doc and say, how's my heart doing back, right? We don't almost ever ask that about blood, but why wouldn't we? to enhance your question.

BRADLEY:  Right. And nobody ever shows up and says, man, my blood is in tip top condition. Right. It's like everything else, but not your blood.

SHERRI:  It's true. But if you think about it, we actually use the blood to interrogate every other organ. Right? So no other organ in the body, the skin, the heart, the kidneys can survive without the blood. And it tells us what's happening with every organ. So in a sense, I would argue, right, like it's maybe the supreme organ of all of them. to your point, right, when we are responsible and we take responsibility, like our skin, like our heart for our own health, we should be informed as consumers, right? What is a normal blood count? 

For example, just with hemoglobin, right? And a lot of people don't know that. They may now know what a normal blood pressure is or that they should look for whatever is in a mole, right? It shouldn't look like that or something's wrong. So we should at the very least know what our normal blood counts are and when they're low and we can talk about, know, in other podcasts you're talking about anemia, but anemia or a low blood count has almost been normalized particularly for women in our society where there's millions and millions.

A third of the world's population walking around with a fixable problem that we just have normalized. it's about in part, right, advocacy for ourselves, for our families, for our patients to say, just like my heart, just like my skin, how do I address the health of my blood? there's nutritional elements to that, or there's testing where things we can look and optimize. I mean, there's a lot of things in that. We've got deep down a clinical hole, but...we should put it at the top of the list because without our blood being healthy, nothing else is healthy either.

Navigating Blood Health Information

BRADLEY:  Yeah, it's fascinating. But did you say in there, what is a thing you can do or how do you, what, where do you go? Is there a place that you can go read about how to make your blood healthy? How do we do it?

SHERRI:  Yeah, I mean sure. So at the very least here, right, I think first it's information. So what are normal numbers? are, like anything else, there's a lot of junk online. There's a lot of very reputable sources about what is considered normal. Certainly speak to your healthcare provider and bring up the topic as we might other parts of our organ systems and our body. But nutrition is a huge piece of it.

It's amazing and back to the anemia topic even in places like the United States or other developed nations where in theory we have access to really good nutrition. There's millions and millions and millions of people walking around iron deficient and eventually they'll become anemic as people who are not even anemic get an iron deficiency. So really nutrition is a huge piece of it. And then another piece of it is that there are millions and millions of people with particularly higher rate of non detection of actually bleeding disorders in women. A lot of people have them. Everybody thinks, well, there's not that many hemophiliacs around. 

There are other types of bleeding disorders, significant percent of the population, which sort of these lower level bleeding disorders, but finding them early, being aware of your own body. When you have surgeries, when you lose teeth, some of these things, sometimes they show up like that and they may not be normalized. So it's really communicating, finding that good healthcare provider, communicating proactively with them and spending some time talking about the health of your blood like you do everything else.

The Role of Technology in Blood Management

BRADLEY:  Right. So we're talking about lab testing that helps to measure these levels. And then I'm a believer in functional medicine, which is a dimension of this that some people don't buy into, for me, it seems like it's been helpful. So, the reality historically was there, there's a lot of change in terms of the perspective on what's the best practices. And then you move into this awakening period where people realize what they should be doing, but then how do you do it? And I think technology is starting to play an increasing role in this. And, clearly you've got a part that would love to hear how you see things evolve. Evolving and how can we get to a future where every provider around the world is optimizing the way blood is managed, kept healthy and ultimately transfused if needed.

SHERRI: Yeah, no, it's an important point and to your point, technology plays a crucial role in this in many ways. I'll focus for a moment on the data aspects of technology and how we can use that. I think to go back to what we were saying a second ago, transfusion became this default position to treat anemia and bleeding, even without good data. We can even see it in our TV shows. We don't even know what's wrong with the patient.

It's exciting, they had an accident, they're in the ER and we're hanging blood before we even know what's going on, right? So that's a little dramatic, but it really has affected the culture around the way that blood has been used. And as a result, clinicians often have a very different perception of what they're actually doing with blood and transfusion and anemia than what they actually are doing. 

That's where data and technology really helps us, what we find over and over again around the world and what published literature says is there's a big difference between where physicians think they make decisions around blood, blood health and transfusion and the realities. So having technology that provides that reliable, actionable data to health systems, to clinicians is incredibly eye-opening. Of course, supportive of education, right? Science has to be there to say we need to do things differently. We need to think differently. Transfusion isn't just the easy answer because it's available, it's expensive, it's risky, all these other things. But here's the data that actually drives the reality of what practice is and where we need to change to.

Global Perspectives on Blood Management

BRADLEY:  So when you were at the World Health Organization event in Malaysia, what did you speak about there? What is that audience interested in?

SHERRI:  Yeah, so you know, again, there are places in the world where blood is just not an option or there's no safe blood available and they know it, right? I've spoken in Malaysia is not fortunately in one of those places, but there are large parts of sub-Saharan Africa where I've sat in conferences and it will be like nothing where a speaker will say, know, 50 % of the blood supply is HIV positive from the blood bank and we use it because that's all we've got or we don't use it because we're nervous. And you think like, did I just hear that? So

BRADLEY:  Oh, this is the, yeah, in this day and age in 2025 that's happening where people are knowingly transfusing blood that's contaminated.

SHERRI:  Yeah. Yeah not because they're bad people, like they'll use what's available, although try not to at all. Right. So, I mean, that wasn't exactly, fortunately the issue with Malaysia, but what is of interest really to the WHO is that we again had this default position, cultural approach to immediately replacing if it's available, this body's liquid organ, yet we have not been good stewards of the blood that's in the patient.

We've not gotten the right data around it. We've not measured it right. We've not paid attention to it and we've not kept it healthy. So that was really a large focus of what we talk about at a lot of these conferences and the World Health Organization Patient Blood Management Policy Brief, which is available online. There's an implementation guide about to be released by the WHO, which actually is going to tell countries what to do, not just like this is important, but how do I actually do something about this? 

But the point being, there's this incredible untapped resource in our own bodies and the billions of people around the world. And instead of constantly turning to the donor pool saying like, how do we get more people to donate blood? And that's not to vilify the generous people who donate, right? 

These are kind, good hearted people, but we will never be able to match up until we look at the supply side, excuse me, the demand side. And how do we reduce the demand? By keeping the blood inside the patient and keeping it healthy. It's very simple. That's really the focus of the World Health Organization working group. The time I spent in Malaysia and these other countries is that we've overlooked this resource, spent our time on the supply side, not on the demand side because we've lacked good information. That's where we need to pay attention.

The Economics of Blood Management

BRADLEY:  So the use of blood clearly has an impact on the patient in terms of their recovery and complications and potentially even mortality. The other side of that is we need some type of economics to support these programs. Why does it matter from a bottom line perspective? 

Where there's no margin, there's no mission, you know, all the realities of the C suite of a health system. was just down in Indianapolis and drove past the new Indiana Indiana university health building. It's a $5 billion from what I've been told about development. So somehow there must be a focus on generating some type of money to pay for those sorts of things. We'd love to hear about the economics of. So patient blood management for a health system. If I'm a CFO, why do I care about this?

SHERRI:  There's a couple sides to that, you know, to the economics and we say that, you know, patient blood management is driven by three E's, the economics, the ethics and the education around it. So, to spend some time on the economic side really.

We can look at really just the transfusion process. Again, the PBM is not about transfusion, but if we look at transfusion as what has been the default position. And here in the United States, hospitals have to buy the blood, right, from the blood centers or from the American Red Cross. Different countries have different models, but we're here in the States, so we'll focus on that. It's one of the most expensive things that a hospital buys, certainly in almost all cases for a laboratory, their biggest bill of what they have to pay for. And again, we're not here to say nobody should buy any more blood from the wreck. There are patients for whom this is going to be indicated. I was very fortunate to be part of really the seminal studies on the cost of transfusion. We published both red cells. We did red cells, platelets, and plasma. And what we found is that to transfuse a unit of red cells is about three and a half to four times the cost of acquiring it.

Now it costs about 250 bucks to buy a unit of red cells from the American Red Cross. That's just a general figure for the United States or a blood center. It costs upwards of a thousand or 1200 or even more dollars to transfuse that unit of blood, right? Because it's a liquid organ transplant. It's time for a lot of nursing time, consent time, testing time, because we want it to be safe. We do. But when we consider, Brad, that at least conservatively 50 % of the time that we transfuse just red cells, could talk about platelets and plasma endlessly, but just red cells, we didn't need to do it. It was either avoidable or completely not indicated. What does that equal? A thousand or 1200 or 1300 bucks, hundreds and thousands of times over for a nation. What does it equal for just a health system?

BRADLEY:  Well, I also wonder Sherri, is there the cost of the medical care following these events? Because as you said earlier, not only did you spend money on the blood product, but if there's an outcome that is negative, they end up being hospitalized longer. They end up having some other type of, related, causal, illness. 

Not sure exactly what those are, but I know like, for example, if you're prescribing people ineffectively, they end up in the hospital and that ends up costing thousands of dollars. So who cares if you gave them a pill that was $50 or less, you still, you know, caused a huge amount of cost. Does blood relate to that too? And has that been studied at all? You know, more of the medical costs related to the blood.

SHERRI:  Yeah, and you're getting really to the heart of the economic issues. Again, I won't give away the age, but when I started in this field, there was really almost nothing in the literature about exactly what you described, really the outcomes piece of transfusion. Then we started to see the one-to-one of a patient contracted HIV. That was a serious event. Fortunately, that happens very rarely. Much more commonly, though, is the sort of standard transfusion to a patient who had a bleeding problem, had an accident, was anemic. What we learned after really encouraging colleagues and publishing now there's thousands of pieces of medical literature that actually was looking to see if we were really benefiting patients because we were doing this all the time. 

We must have been contributing to better outcomes and exactly what you said is the case, what it showed that in the vast majority of cases, we may have fixed a number on a lab test, but we actually contributed to a poorer patient outcome, longer length stay in the hospital, you want to name the list, we could go all day, more cardiac complications, increased admission to the ICU, on and on and on. Maybe we really want it. And again, we're clinicians, right? We are in this business because we want to do the right thing for patients. So we thought we did the right thing, but because we really didn't have the evidence to back up the fact that we were helping patients, we learned that we were actually, in many cases, contributing to poor outcomes. That costs a lot, aside from just acquiring and giving the product that seesaw doesn't tilt towards benefit, all we're giving is risk and cost, right, to our patients.

BRADLEY:  So just the purchase of the blood is worthy of a CFO's attention because it's such a high cost item. But then if you also tie in even that bigger cost of ineffective or suboptimal utilization of the blood product, now we're getting into another layer of impact economically. I will admit, and you see this too, that

SHERRI:  Absolutely. Absolutely.

BRADLEY:  It's very difficult to determine where attribution should go for that downstream medical impact. But this seems like a pretty linked reality where you could study it over time and say, when blood was utilized in this way, things went a certain direction that was less costs, better outcome. These other decisions led to higher costs, worse outcomes, which is, it's, think somewhat of the future of how healthcare gets improved is to begin connecting the dots. I think about the patient journey and that historically with lab information, with, with diagnostic information, it's point in time based on some acute issue. And there hasn't been a longitudinal or life long understanding of what was happening with that, that individual's health. And it sounds like in this case, you are really driving a value proposition that starts to connect those dots more as it relates to blood.

SHERRI:  Sure. Exactly. Yeah, I think you're making a really good point. Really does connect patient blood management as a really nice fit with the patient journey because it starts right in the primary care space. It's the lifespan of the patient, right, even from birth all the way through. Again, that blood tells us about what's happening completely with every other organ system, every level of health in that patient, but be able to personalize that information and get that data reliably, accurately, and then in a meaningful way to utilize it, right.

Transfusion is only a piece of that. That's an intervention. Much better to personalize that care over the course of the lifespan to lead to better health and ultimately better outcomes and better quality of life too. know that when we do the right thing for the patient's own blood, we don't just do the right thing economically into their outcomes. People feel better. They are more productive. They're better able to go to work. It affects the GDP of countries for our blood health. So there's a lot to talk about here.

The Future of Patient Blood Management

BRADLEY:  So where is this ultimately going? If you looked forward another decade, you've seen history and that helps inform what will happen in the future. Where are we with patient blood management in 10 years?

SHERRI:  Yeah, it's exciting because I think we came out farther than we ever thought. I think we have more work to do and we are making progress again with the global recognition that we have this untapped resource. I kind of look at it a little bit and this is not a political statement, but a little bit like green energy in the sense that there is still a place for traditional fossil fuels, et cetera, but there's a concept that is in some way a resource that will not last forever. So it doesn't go away, but it always has its challenges. What are other sources and how can those things work together for the good of humanity but also for the good of business, right? Those two things can co-exist. 

So as we look at patient blood management, we have this untapped resource of the patient's own blood, which we, with good information, with good data, with good lifelong understanding through the patient journey, we can optimize that blood health, I think we can do that in the next 10 or 15 years where this becomes a high priority not just for you and me on a podcast but for physicians, for hospitals, for ministries of health, for departments of health and human services, whatever it's called in a country for entire nations. Because when we really look at the data, I wasn't joking when I said that, now, anemia, and not having good blood health affects, we can actually have measured that in several countries, affects the GDP of nations because it affects people's ability to be productive in society. And it's something that's actually easily treatable. We just have to do it. 

I think the future of patient blood management is this recognition at a national and global level that this has to be prioritized. And while transfusion may never go away and we appreciate the kind people who donate, this is not about that. This is about optimizing a resource and improving a resource that already exists. There, again, there's an ethical reason to do that. There's the evidence behind it. And there's the economic reason and the economic benefit at certainly a health system level, but a national and global level too.

BRADLEY:  Well, it sounds like this is an area that you're really passionate about clearly. And also it's an area that you've made a big impact on and you're, seems as though to me, you're just getting started in many respects. So really awesome to learn from you today on the Boombostic health podcast, Sherry, and thank you for being such a key member of the team at HSC one as well. We'd love to have you again sometime in the future on the podcast and really appreciate you being on. 

SHERRI:  Thank you so much, Brad. It's been great to be here. 

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