How Digital Technology Can Empower Healthcare Consumers
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How Digital Technology Can Empower Healthcare Consumers

– Welcome, and thank you for joining. This is the Yale SOM Exchange Webinar. Today’s topic is how digital technology can empower healthcare consumers. We have a lot to get into and
we have a wonderful team here for discussion, so let’s
just get right into it. First, let me introduce myself. My name is Greg Licholai. I teach at the Yale School of Management, a capstone course on sustainable
innovation in healthcare, and I’m also the Chief Medical Officer at a global company called
PRA Health Sciences, which is a contract research
and data informatics company that works with pharmaceutical
and biotech industry for drug development. As part of Yale, we’ve also
initiated a number of programs to support and study digital healthcare, most notably, we have our own study group that’s focused on novel
healthcare therapeutics, which has led us to work in
wiser capacity with the FDA, as well as some of the new
professional organizations such as the Digital Medicine Society and the Digital Therapeutics Alliance. So now let me first introduce our, our speakers for the webinar. Let’s start with Sri Muthu. He is a class of 16 from
the School of Management and he is CEO of a venture
firm called Health Ventures. Sri, could you tell us a little
bit about your background. – Sure, thank you. I’ve been primarily– Thank you Dean. I’ve been primarily a technologist for, I’ll just look at my thing, since 1989. Professionally in financial services and then over the last six years switched over to healthcare and its really, seeing
very similar patterns in the industry around consumerization that I’ve seen in other industries. So, that’s my primary background and most (inaudible) 2016. – Excellent. Let’s move on to Rob
Stavert, with a class of 09, and he’s head of Clinical
Affairs at Medumo, and also Chief of Dermatology at the Cambridge Health Alliance. Rob, can you tell us a little bit more about your background. – Sure, hi everybody. So as Greg mentioned, I did the combined joint
MD MBA program at Yale and graduated from that in 2009, and then subsequently went on and did clinical training in dermatology which I also also did at Yale, and then moved up to Boston afterwards, where I split my time as a
(inaudible) clinical practice. (inaudible) required this
past July by Phillips. And so, Medumo is now
officially a Phillips company, under the Philips umbrella. And so, been a rewarding
experience on the clinical side and also getting to use some
of that clinical experience to try and build a digital health startup. – Terrific, well congratulations
on those achievements. All right. Finally, let’s move on to Jen White. She is class of 18 at SOM. And she’s currently the
Senior Vice President of Strategic Partnerships at Klick. Jen, tell us a little
bit more about yourself and a little bit more about Klick. – Sure, so hi everyone. It’s a pleasure to be here
speaking with you guys about one of my favorite
topics, which is obviously, digital health and empowering patients. I guess, I’ve grown up in
the digital health industry. I had background was
Web MD for seven years, and then I went to a
privately held company that was focused on the
same types of products and offerings to physicians and consumers. And today I am at Klick Health. I’ve been there for about four years. And at Klick, Klick is a privately held commercialization partner
for life science companies. And so, ranging from everything to marketing communications programs to patients, and to physicians for products that are on,
you know, within the market, to incubating startups like Circulation, which was later exited to Logistic Here. We really run the gamut in
terms of the different types of ways that we leverage technology to, to really empower and educate that patient and physician audiences. And I graduated in 18, from Yale SOM. – Excellent, excellent so clearly we’ve got an excellent group here that has a lot of expertise on this topic. Let’s do some, let’s
do some ground setting, at the start. Particularly because, if you’re like us who pay attention to digital healthcare, digital technologies, there’s
a lot of noise in this space. And in, there is in fact some, some criticism and some cynicism about
digital technologies, the impact of digital technologies and digital therapeutics. Let’s all get on the same page. Let’s define what we mean
by digital technologies. From the point of view of healthcare. Jen, let’s, let’s start with you. Can you define what, when you, when you hear that phrase
digital technologies, digital healthcare, digital therapeutics, how do you, how do you
get your arms around that? – Um, well it’s interesting. So to me, those phrases are
three very different niches within what is, the broader
digital health ecosystem, reaching and engaging our
consumers who are leaning in, and wanting to have.. and also physicians, who are wanting to have more power within their managing their own health. And so, you know, when I
think about technologies around digital health, I mean, quite frankly, I
think the internet (chuckles) ‘Cause it’s, you look
at Web MD and Medscape which, you know Web MD went public with (inaudible) Healthian in 99, and it was actually acquired by KKR in 17, but over the course of that time it took information that
previously was only available, you know, as a consumer you would go into your physician they would tell you what was wrong with you, they tell you what therapy you had and you would leave and say thank you. (computer bell) What Web MD did, that I think was really
ground breaking was, they said, let us provide you with access to all of this information around the conditions and therapies And it, and at the time when
they started in 99, 2000, I joined in 2006. It was, it was unheard of. And this idea of talking
to marketers around, you know, our physicians on the internet. Turns out they are, and physicians are healthcare consumers just like patients are. So allowing these different
audiences to engage in information at a time and place that’s convenient for them, you know, in the privacy of their own home, and to also then take it one step further and take information and
make it easily digestible by a consumer audience, you know, so taking complicated
topics that might not, that might feel very stigmatizing and making it available in language that they’re comfortable with, is to me, one of the greatest benefits of this digital health era. And so, so to me that
digital health technology starts with the internet. And then of course, it gets
more specific from there, but that’s how (whispers) – That’s a great overview. Rob, let’s talk to you, so you know Jen just talked
about digital technologies in sweeping terms, and including bringing information and making really simplifying the experience for patients. Could you, could you answer the question How do you and your firm
define digital technologies, and then how do you approach that from an enabling solution? – Yeah, I mean, I think, Jen nicely summed it up,
I think in terms of just, it brought an increasingly broad term about how we think
about digital technology from health care is you know, I guess, maybe a kind of encompassing
way to think about it, is just web or mobile based technology that allow for delivery
of healthcare content and health care services that traditionally were accessed, primarily through other channels. And you know, from there, increasingly, there’s a lot of offshoots of that via artificial intelligence
based services, analytics. But that’s, I guess, kind of a broad way of how I would think about it. And then, in terms of
how Medumo, our startup, was kind of thinking about it. Actually, in a lot of ways, similar to what Jen described, where we really started the company was recognizing fundamentally challenges in Asian education, and it was really, the most of the people that were involved at that early stage were clinicians, were providers who are seeing patients, including myself, and
recognizing that very often there are, just very, this big gaps in providing patients effectively, getting the information they need, in order to to get the
health care they need, to have a better outcome. And so we tried to think about ways that we might be able
to leverage technology, to improve that problem. We saw a few gaps and what we thought were the way that hospitals in particular, we’re leveraging the technologies that patients are using the most, specifically cell phones and email, to reach their patients in a way that really felt personalized and really was linked to
specific episodes of care. And really started with there, to try and see if we could make an impact on some of those problems. – That’s very helpful. It’s very, very helpful. Sri, tell us from a point of view, as a venture investor, you must see a lot of different types of digital technologies. Give us an overview of
some of the technologies that you’re seeing, and with a particular filter of, what do you consider within scope? And what would you consider out of scope, as a digital healthcare technology? – Direct (clears throat) So as a VC let me frame myself because I always think about exits. Right, I’m always
thinking about the product that I’m investing in now, in terms of five to seven
years down the road. So when I look at the technologies that are out there today, that we call digital
technology in healthcare, I primarily break it down into sort of the high level categories, around what is, what
are the clients using? The end users? What are the providers using? What are the resource managers using, meeting systems and so forth? And what are the data providers using? And this is sort of the same framework that will help organization does, right? And so you see things like very customer centric solutions or patient centric solutions. You see healthcare
provider centric solutions. You see resource managers solutions. You see data center
solutions and data sets. However, so those what I see today. So you know, we see IBM Internal Health Company we invest in, TOTAL MAMA, very patient focused. We have a mental health thing out of Yale, that would, might help the parents focus and systems focus. But, stepping back and looking
at this overall framework from a perspective of five to seven years, and seeing this in another industry, is this idea that we used to call banking, PC banking, and then we used to
call it online banking, and then we used to
call it digital banking and now we just say, banking, and it cross cuts across
the entire spectrum kind of like what Jen was speaking to. So in healthcare, I see
sort of a similar pattern happening for digital technologies right? At some point, no one’s
going to talk about digital technologies
separate from healthcare. It’s just going to be the frame
that we use for everything. There’s not going to be a single physician that’s not going to use some form of EMR. There’s not going to be a single patient that’s not going to have some sort of device on themselves, whether it’s a scale at home, or Alexa giving them advice, or a watch, or a digital therapeutic
product out there. There’s not going to be a hospital that’s not going to use technology. It’s just going to become the suit they’re wearing, right? And so then I asked the
question for myself. If it’s any time, to go
back to Jen’s comment and Roberts comment, and it’s anywhere, my key interest right now is around, how does it impact the any one that we define in healthcare right now? ‘Cause in healthcare, we still have this unique proposition thing we learned in your class, correct? You know, physicians are the only ones allowed to practice medicine, and the digital technology has broken that framework, right? Because in banking, used to
be only banks can be banks. Now, there are 36-something neobanks. There could be only
doctors could prescribe prescriptions in person, I can now get a prescription
over the website, and have it delivered to my house and have them do a follow up query to check up in my labs, without ever seeing a human being. – Quite, quite fascinating,
quite fascinating and, you know, timely, the FDA is issuing new guidance documents on approving AI empowered software as a therapeutic, so quite timely, this shift
the definition of who, who can, air quote practice medicine. I’m building on that,
Jen let’s shift to you, and consider stakeholders here so this discussion is focusing on health care consumers. Maybe we turn that a
little on its side and say, as you’re thinking about
enabling digital technologies, what stakeholders need
to be prioritized in, in order to reach a level of impact? – Such a good question. So, I mean, I think,
again, it goes back to what both Rob and Sri
talked about which is, you know, oftentimes, you’ll have a technological solution that is targeting one
specific stakeholder. So, if it’s a consumer facing technology, an app for instance for, it’s called MYME, that I know Sri’s familiar with as well. That is focusing on helping patients be more empowered about
their autoimmune condition. So then clearly those
stakeholders, patients need to understand and be informed about this new technology. How to leverage it, the coaches that are part of the app, the healthcare coaches, helping bring about that better dialogue. But then, of course, bringing
along the physicians, and so physicians are
an interesting nuance of this equation, because as I said at the beginning, physicians
are healthcare consumers as well, and either they’re
consuming the information for themselves to become
better practicing clinicians, you know, whether staying abreast of the treatment guidelines and those types of things and so engaging in content on a Medscape or an up to date, or an Epocrates or one of those very
specific position partners, or they need to be ready
for the conversation of this more empowered
healthcare consumer. And so, you know this,
it’s a shift in terms of, you know, 25 years ago, 20 years ago, the clinician, Doctor Lookalie
saying to the patient, you’re sick, and I’m going
to tell you what to do, as opposed to the patient
coming in and saying, well, gee I researched these conditions, I think this is what I have and I actually think this is the treatment that might best help me. And so making sure that
you’re equally educating the physician to be prepared
for that conversation so that they know what is– what their patients are
going to come in and say, I think is really important and it’s something that has evolved as the different
technologies have evolved. – Fascinating, and it’s, so you mentioned, you mentioned this trend of patients being better educated about
their own health care. Let me jump to Rob, you’re a physician, you’re a dermatologist, and you’re also involved in these novel digital applications. Tell us from your point of view, the experience that
physicians are having today. Not, not the, you know,
aging physicians like me, (Jen chuckles) but physicians today, who
are probably, you know, used to growing up with
tools like the internet and their experience
with some of the things that Jen mentioned of more, you know, smarter patients, more informed patients. And I guess the, you know, are physicians continue to be kicking and screaming dragged along to this, or are they beginning to embrace some changes that Medumo and your colleagues are working on? – Yeah, I think, I mean, I think there’s a spectrum, certainly, in some, I mean, not to over generalize probably, some of it is, there is some amount of
that’s age related I think in terms of, you know, it’s probably easier for
some of the newer generations of physicians who’ve been accustomed to using technologies at
the start of their career. Compared to folks who are towards the later stages of their career who have been less
accustomed to using things, practicing a certain way and having to make adjustments to how they’re practicing, and I think that was something I noticed, in particular I was at, as I’ve been training in my practice, I’ve been at two different institutions where they were implementing a new EMR. And so, going from paper
based charts to EMR, and so there were some physicians who just elected to retire, rather than have to kind of
make this big adjustments to their to their practice. So I think that’s, you know, there is certainly a spectrum, I think, probably for the newer generations and certainly some folks of all ages who are a little bit, either more friendly or technology friendly I should say or were more kind of open to
learning and experimenting and trying new ways of practicing. You know that there’s
certainly a spectrum. I think, I think one thing that may be, I noticed with patients I see is, there certainly seems
to be a also a spectrum in what patients expect
from the health care system. And I think that in some
ways is driving some, some change on the part
of healthcare system. So, for example, access in
my specialty dermatology is a big challenge in a lot of places, and for a lot of patients, It’s completely unacceptable when they’re either accustomed to accessing other types of services, healthcare related or not. Instantly, and having
things, basically, you know, delivered to them, accessible via the web, things like that, instantly. The idea that you have to, you know, take, you know, a half day off work, maybe have to wait a
couple months to be seen for an appointment that
may last 10 to 15 minutes is just completely, it just
seems completely antiquated and completely not aligned
with their expectations of experiencing a high quality service. And so I think it’s one example of how I think patients or healthcare consumers and patients are driving a lot of change in health care service
and service delivery. It’s also creating
opportunities for, you know, other companies to emerge that may be, are filling in those gaps and meeting the needs of
those patient populations in a different way, where the current healthcare system isn’t addressing them directly. – Can I build on something that Rob said? ’cause he brought up
such an important point that we hadn’t discussed yet, which was the EHR, as
part of this workflow and in physicians are being
asked to do more and more with patients, capture
more records, etc etc, but less time, right? And so I think, as you’re thinking about the stakeholder engagement of physicians and consumers
beyond just educating, you have to have tools and technologies that are within their workflow and working well with the HR. And so, as I think
about a technology that, Klick developed, my company developed with Boston Children’s,
their innovation group is called Health Voyager and you can look it up, But it’s, it was a two folded, or two sided solution. One was taking information that clinicians were
already capturing in the EHR and creating an a more
user friendly format and digestible format for the patient and then the second piece was actually a patient app, leveraging that information that was the output from the EHR, to then create this very
immersive VR experience. Highly personalized
medicine for the patient to take something very very
complex like a colonoscopy and put it literally in the patient’s eyes of seeing it within their own body. And so, The extent to
which these technologies can marry both the EHR and what’s happening in that workflow and not increase the
workload for physicians. I think is, really it’s,
you know, table stakes. You have something that
has to be accomplished. – You know, quite
interesting, quite interesting and it feels like there’s
a heavy lift here. A little bit of an anecdote, so I was at some conference
about six months ago, and I happened to run into an individual I did not know, sitting outside, and he seemed like a very happy person. And I asked where he was, you know, what he did for a living,
and he was a physician. And I asked him the
very specific question. You seem much happier than many physicians in private practice that I know. Can you explain that to me? This was his answer, he said, “I eliminated the EHR,
the EMR from my practice. I only see patients of one on one. I have a small group of patients I see, and I do nothing electronic.” So, let me ask this question to the panel. So, if we, again we’re patient, we’re focused on empowering
healthcare consumers, let’s move over to the patient as a consumer of healthcare. How would you, how would you fill in the blank here? Dear Doctor, It’s important to use EMR’s, because it empowers patients
in the following way. – Today I don’t think it does. I mean I’m just going to put it out there. I think the promise of
the EMR is so important, but at this point with as a patient, the struggle of getting your information and extracting it from an EHR. The lack of interoperability between, you know from one system to another, you know Rob said, if
you focus on dermatology, you might have one system as opposed to, and then, you know, you
might have something completely different for your cardiologist versus you or someone else or your primary care physician. And so, if those things
talk to one another and I had access to it, without having to remember 15 passwords, I think that would very much empower me. But as it so I think the idea is amazing. And it hurts my heart to hear, you know, because I do believe in the power of data, so for a physician to say that they’re completely
doing away with it, and his life is better. I hate that because I
think what is possible when you have this data captured in a way and where your conditions are managed in a holistic manner and your, you know, all different types of
specialists for contributing to your one patient records,
is to me the utopia. I don’t think it exists today. – Okay so– – Rob is a clinician, so Rob might tell me I’m totally wrong and.. (chuckles) – Yeah, let’s go to Rob. So can we put that down as a
no, or is not yet from Jen. I think, I think we’re in the
midst of a time of change, and I think even in the
relatively short time since I graduated medical school, I think I’ve been a witness to that and there’s some healthcare systems that are further along that curve and some that are still catching up. When I did my internship year, so my first year out of medical school, working as a general medicine internist and a big academic Hospital in Boston, which is 2009, 2010. There was an EMR but it also was, there was no ability to communicate with other hospitals electronically, even some that were located, you know, literally across the street
from where I was working. And so it was not uncommon
to have a new patient you’re admitting in
the middle of the night and been trying to contact a medical records
department that’s literally, you know, not even a
quarter mile away from you, and then trying to get reports faxed over to the fax machine and
standing by the fax machine, waiting for the results of
the CT scan that was done. You know, just literally down the street and but today I would say, you know, where I’m practicing in
Boston at the moment, certainly a lot of the, I think, the main place I see patients was relatively early in the curve and adopting a large EMR, so a lot of the rep, there’s
a pretty robust record system for patients within the system, primary care, specialty
care, imaging, lab tests, etc and increasingly an ability for that system to communicate, not only with everything internally, but with their hospitals in
Boston, in Massachusetts. And so, so it’s sort of an anecdote but i think it’s progress, you know, and, you know, it’s a large, these are large complicated
high stakes systems to change and overhaul. And absolutely, we’d
love to see, you know, things moving that direction
faster and more safely but I feel like I’ve been
a witness to some of this, to some of this change, and you know the story I mentioned earlier and maybe to Greg, like your point about the provider you mentioned who’s very happy. Anytime there’s change, especially changing big systems, it’s going to create some
pain for some people. And I think that, you know
as providers, as patients, we’re all adjusting to some of this change but i think that we all believe that over time it’s putting
us in a better direction, and ultimately, we’ll hope.. We as healthcare providers and patients will be better off for it, but we’re in the midst
of a time of change. – Change is often painful. So, and Rob, you use the F word of healthcare technology, facts. (Jen laughs) So Sri, let’s shift to you. Break this down for us. So we want to talk about
empowering consumers. Let’s talk about empowering patients. How do these technologies,
empower patients? And if you want to answer
the question about EMR’s, or if you want to talk more broadly about digital technology. – I think to sort of build on what everybody’s been saying. So first of all, I just recently joined the state of Connecticut’s Board of Health Information Exchange. It’s been a project that’s been in progress for 10 years. This is the third time they’re starting to exchange healthcare data among all the different
various healthcare entities. And my first question when I asked, when I joined the first board meeting was, hey if we can do this relatively easily for pretty much everything else except in healthcare, what’s the holdup? And I think Robert spoke about this, about the idea of change causing.. Healthcare is something that
people feel so personally about from a consumer perspective. Something that physicians
feel really personally about from their expertise in their careers and everything else. If I looked at what shifted, right? EHR has only came on board because of meaningful use, right? There was money being set aside to say you shall go to
electronic medical records. Now there’s going to be
money being set aside to say that you will have to interact in, to be interoperable with
your data and exchange data. So to your question then as a consumer, as a patient, as a healthcare consumer, how do I see this? I want to, I want to
think about healthcare in the way that I think
about everything else, which is, I don’t think about it, right? If I want to go look up my taxes, or my bank statements, or my Lyft records or my Uber records, I just go online and I see it. It’s really not a lot of difficulty in finding that pieces of data, right? However, if I wanted to go look up my healthcare records, now, it’s fax, starting from day one, right? Phone calls, emails,
a series of exchanges. I think we’re in that transition stage where we’re still
thinking this is the norm, and struggling with the change when pretty much every other
industry that used to be, I grew up in a culture
where you had to go walk about a mile to the taxi
station to get a taxi. You had to go someplace
to get a taxi, right? I came to the US, it was great. I could call the taxi to my house, and now I don’t even think twice about using Lyft or Uber or
any of the taxi services. And it just becomes the factor and I think that’s what consumers want with their health care, right? I want to be able to pull up whatever modality I have, whether it’s voice at home and Alexa, whether I’m in my car driving my Tesla and it’s checking my temperature and saying, hey you look pretty warm maybe I should call you down a little bit, or saying that, you know,
I find something in your, in your medical records that
usually needed updated on. Or I’ve done a gene test and now this new reports that came in, that has an impact to me, that it tells instead of me looking. I think as a patient that’s what I want. I want it to look like, pretty much any other
consumer product that I have, and health care still
doesn’t think that, right? I spent a lot of time
talking to physicians and hospital administrators and insurance that they get digitalization
for themselves. Because there’s money coming in, or the requirement for data, or there’s a requirement for research. They don’t get it from the perspective of digital experience, where the consumer requires, as Jen has pointed out, and end to end intro
interoperability, right? It’s not just the consumer app, it’s not just the data app, It’s not just the insurance data, it’s not the EHR, but
it’s literally everything in the ecosystem needs to be connected. And that’s I think where
we’re going to move to whether we like it or not, and you seen some of the
other parts of the world, but I think the US is
actually behind, right? You see some of the folks in Asia and some of the folks in Africa, low resource countries, are already kind of moving that way just because they have to and they don’t have this legacy burden that we’re carrying around. And that’s what I think is going to shift. We’re going to play catch up. – You know, so technology
starts as science fiction, but it winds up, ends up
being plastic forks to knives. Something that we just
use ignore and dispose of. – [Sri] Right. – So, we’re, I’m going to nudge our video participants, or virtual participants
here to send in questions. We’ve already gotten a
couple of excellent questions so let me start with, with the following to anybody on our panel. Can you clarify what is
a digital therapeutic? And what are the requirements to differentiate products and services as digital therapeutics? Who’d like to take that on? – Well I’ll, I’ll start. Just because it’s something I’ve been involved in pretty recently. So Greg, you mentioned that you’re working with the Digital Therapeutics Alliance and that’s actually something
I’ve been involved in, over the past year or so as well. And so I mean as you look at this movement from digital health,
which is, I think, again, a broad term of general health and wellness information
delivered to a consumer via some type of a digital technology, whether it’s the mobile app
or internet or whatever. To a digital therapeutic,
you start to increase in terms of FDA, actually looking at the FDA as a clearing the device for instance. You physicians prescribing
the digital technology as opposed to just having it available for general consumer consumption. And so you mean there’s some
really exciting examples right now in the industry. Ground leader, you’re
groundbreaking leaders like, you know, Akili for ADHD where there’s clinical trials underway to evaluate the effectiveness
of this technology for adolescents with ADHD, you know in a non pharmacologic way but it’s a be a prescription therapy. You know that’s one
really exciting example and there are countless others. And so to me, it’s you know, having a physician prescribe it. It is the FDA rigor,
it’s the clinical trials. That’s what makes a digital
therapeutic, in my mind. – Yeah, yeah. What’s the role of regulators and the FDA in digital therapeutics? Rob, Sri, do you want to
help us understand that? – Rob do you want to go? – I may not be the best
person to answer this one. I think for, you know, for the company that I was involved in we, we, kind of, we intentionally sort
of steered around it, in the way of trying to really steer away from providing therapeutic or kind of concrete medical advice, more just providing more of the information that the clinics had wanted to have the patients in their hands, and then when there were
situations where it called for, you know, physician intervention or anything like that, defaulting to having the
patient contact the clinic, contact the position and making sure that it
was easier for the patient to have that information available. But we saw, it was, there
were several conversations we had around, you know, how close do we want to get,
to giving medical advice? Or what point can we start
to run under the risk of being under some amount of regulation? And we felt that because it
was a little bit nebulous and not necessarily, directly the problem we were trying to solve, we kind of steered clear from it. – Thank you. I can add to that. So, we had been working with the FDA, we’re working with them, specifically, on some of the new piloting
programs for digital health and trying to understand
the new guidelines. And as a V.C, I kind of, sort of, simplified to my portfolio
companies as two perspectives. Do you want to be a vitamin company? Or do you want to be a
prescription drug company, right? If you’re a prescription drug company, you’re going to jump through all the hoops that the FDA is going to
make you jump through. But you at least you’re
going to be something that is, really, somewhat
evidence based, air quotes here, and has potentially a
much higher probability of getting reimbursed by the various payers in the system. Where else, you know, vitamin industry is a very, very popular industry, it makes a lot of money, right? But there’s really no
regulation in that space, right? Can be anybody that’s happening, and that’s typically how I differentiate between these two spaces. I think the FDA is trying really hard, along with some of the other governmental agencies around the world, to try to get their arms around, basically the industry, that’s kind of moving ahead of them, and they’re playing catch up, and they’re trying to apply it, and they seem to be fair. The FDA seems to be smart
enough to understand the folks that we’ve been working with, they can’t apply just the same processes, the same years long waterfall processes. To digital software, which
is typically far more agile, far more scale, you know, our products within two
years of being built, are now in three different countries. That is not something you think about with a pharmacological
intervention, right? – Yeah, yeah, yeah. We’re getting a lot of good questions about data in the role, of data in digitalization and technology enablement of healthcare. So, you know, we’ve
touched on it a little bit with the EMR’s, but we have a good, a good way to think about healthcare data that comes in, in this question. Is healthcare data– Yeah, I guess I would summarize by saying, What’s different about healthcare data? Is healthcare data more complex than data coming from places like finance and transportation? I mean, it is some what
shocking, you know, the example that you gave Sri, that we can do online banking but it’s hard to do online health care. Yet, it’s our health as
opposed to our money, which is more important. Is that data more complex? Is it more important? What contributes to
healthcare being behind other industries in digitalization? Whether it’s, whether
it’s a data aggregation or other aspects? – I’ll take a first pass here, and I’d love to hear
some data perspectives. You know, I’ve built
very large data systems, exchanging data across countries and different industries both in finance and in academia and so forth. Healthcare data is not more complex. I hate to say it that way. There’s one exception, genetic data is a beast by itself. There’s really no other analog, in any of the other industries, except maybe petroleum. But, excluding genetic data for this time, just for the sheer scale and size of it pretty much everything else in healthcare and, you know, whether it’s
using Hl7 or using FHIR, using some of the
standards that we’ve had. We’ve had an Indian this summer, basically doing analysis of data strategy guidelines
for all our startups. For boards, no privacy
regulator was paved. The framework is there,
it is not more complex. What it is, it is
ridiculously unstructured and very few organizations
are really going to, using some kind of
standardized formats around, well, around the country. Use a simple example. If you are moving money between banks, are you using ACH or
Swift around the world. There is no equivalent standard yet. And I think that’s what’s
driving the lack of, and there was no economic need to exchange data in the past. And so there was really no driver for having this data be available, right? For everybody else. I also think– – You know, people discuss the so called interoperability problem. Could you could you define that for us? – Oh, it’s a fact that I can be in one of the four Yale hospitals here, and the other one can’t
see my record, (chuckles) is the negative of it, right? We just don’t speak the same languages, and there’s really no incentive for the existing service providers to allow that to happen. They all claim they’re trying to but there’s actually, from a pure economic perspective, there’s no incentive. – So, Rob let’s turn to you. There’s a, and let me frame it this way. There’s a new proposal that comes from health and human services to provide data standards
that ultimately will require EMR and data companies to provide API’s, which are portals of course, that allow consumers access to their data, and allow consumers to
provide access to their data to whoever they choose. Perhaps it’s an AI company,
perhaps somebody else. But I’m going to ask a
question about HIPAA. So is, and this is a question that’s come comes from our audience. Is HIPAA, an impediment
to interoperability? Is HIPAA an impediment
to doing some of these, solve some of these
problems, like Sri mentioned, that these EMR’s don’t talk to each other. – I think it’s been a,
yeah, I mean, I think it’s a challenge for sure and– I think you could use
that word but I would, I would also say a necessary one. A lot of times I mean, patient, patient healthcare information is really, it’s obviously very
important to keep protected and to keep private and make sure that whatever channels are
being created are secure. And I suppose you can, you could say that an advantage of the
antiquated fax machine system that we had previously, was that when it was working, that people had to, you know, the records were stored somewhere under lock and key supposedly and people had to sign a release, and it was a least an easier, physical way to make sure that patients information was was protected safely. I’ll say that I think most of the times I find when talking to patients though, I find that most patients are very willing to have their information be shared amongst their providers, amongst other people
involved in their care and there may be cases
where they’re exception but they’re the exception
and not the rule. And so, I do wonder at some times whether the degree to which we’re protecting, has become kind of more of a barrier. When we were starting our company, it was something that we had to be really, really conscious of, when we were kind of
starting from the ground up. It took a lot of trust
and relationship building to allow this nascent startup to engage with healthcare systems data, and we had to take on some risks to, and ensure that, you know, all of the places we’re storing data we’re going to be completely secure. I think sometimes, that can maybe serve as a bit of a barrier for new companies starting up. Kind of winning that trust
of healthcare systems and allowing them to get some pilot data, get going and get up and running. So I think, yeah, I do think it’s been an impediment to some degree, but I think in a lot of
ways, a necessary one. But hopefully as the time goes on, the security amongst an
interoperability challenge will be reduced and hopefully be able to have a better flow of data, better and proper data. – So healthcare data has been calculated to double every 120 days, or something like that. Which means three times
a year, which means, that in the next few years, we will be swimming underneath avalanches, and oceans and tsunami’s of data. Now, we’re getting a number of interesting questions about, maybe not promises about it, but some of the concerns. If we do solve the
interoperability issues, if we do connect data sources, that’s just more data, more information. How does a– Let’s take it from a
doctor’s point of view. So Rob, let’s stay with you for a second. So as a doctor, I can’t imagine that any individual can stay on top of all the healthcare
information that’s out there. And as it increases and as we’re more and more connected, you know, maybe we should take the point of view of
that individual who said, “No, I’m going to put my brakes on it.” Is this going to just increase
the anxiety of patients? Is this going to increase
the work burden of doctors? Is this going to, in
fact, increase utilization and drive up health care costs? How do you answer that? – That’s a great question
and I think unfortunately, a lot of those outcomes are possible, especially, you know, in the midst of a time of change. I think some ways that I see it happening, I mean, I think having that fast, rapid increase in data, probably lends itself clinically
to more sub-specialization, I think because it’s harder and harder to be a really broad generalist and really staying on top. On top of your field, with
the level of expertise that patients will want. And as you have more
and more specialization, I think that also lends itself to much more team based care. We’re already seeing that clinically, you know, with the rise of a ACO’s over the last few years, and really thinking about patient care being delivered from a group of people, and people needing to understand the different roles that they have within a particular team. I think another aspect of your question, I think it’s important
for any of the companies or firms producing this type of data to just be really thoughtful
about physician impact. And I think that was
something, that I think we tried to be thoughtful of when we were starting up. Probably not coincidental, that we had three physicians on the, you know, among our original Co-Founders. So another anecdote, so right now, if a patient has a concern,
they can access me. Some patients will have my phone number. I have two work related email accounts, for two different places I see patients. Certainly nursing staff in both offices have my phone number. And then patients can communicate and do, directly through the electronic
medical record as well. So there’s, there’s no shortage of ways of patients to get access. And so one thing, that
we were thoughtful of from the beginning was, we didn’t want physicians to feel, kind of, adding to their, we didn’t want to be
adding to physician burden. We didn’t want to be adding to
channels with our technology, of ways that physicians were expected to be accountable for
patients reaching them through this way because most physicians already feel like there’s
too many channels, that they’re kind of responsible
for managing already. And similarly, we saw a challenge where we saw, or an opportunity perhaps where we saw a lot of early stage startups that were showing a lot of progress, that had a great patient experience, and having had great
tools for capturing data. And it was sort of like the, in order for the startups
to realize their potential, is sort of saying, all we have to do is, you know, get all this data and then we’re going to
give it to the doctor and the doctor is going to be able to, like do all this awesome stuff, to take better care of a patient. And as providers were thinking, I don’t know what to do with all this reams of data coming in. So basically, when we built our company, we made it such that, the physician didn’t have to do anything. Literally the physician did
not have to do anything. If they wanted to, or if there was a particular scenario where physicians wanted to, they could, we could have custom reports and custom sets of data delivered to them about a particular episode of care, type of episode of care,
or patient population, or something like that,
but the default setting, was basically, the
physician has to do nothing. And so I think that, you know, recognizing that physicians are already kind of overwhelmed and inundated, with all these data sources. And having new technologies
be thoughtful about that is really important for them to grow. But similarly on the clinician
side of that, you know, we have to be thoughtful about recognizing that these changes are coming and trying to prepare ourselves to be adaptable, flexible to manage them. – And actually if I could
build on that a little bit. I also think if we look at the cost of healthcare and the consumption of care. You know, Rob I think
did a great job speaking about the clinicians and the consumer but also looking at the payers and ensuring that we’re
effectively aligning incentives so that payers are
recognizing the validity of some of these alternative
treatment modalities. Whether it’s telehealth or, you know, for behavioral health, maybe it’s text based behavioral care. So that you’re using
digital health in ways that might be equally,
if not more effective, but at least equally effective through a digital platform. Thereby, maybe, freeing up resources in the more traditional
healthcare setting. It’s I think that’s one
way of looking at it and ensuring that the payers are aligned with recognizing the
validity of these tools and reimbursing accordingly. But then also, one step further, is really ensuring that the patients are automate, so that technologies are automating these kind of low value
tasks, if you will. And so using a bot, for instance, to answer very simple Q&A like, I just called in yesterday to CVS, because I’m waiting for a refill from my daughter’s prescription, and I didn’t need to come to a pharmacist. I just needed to know if
it was ready yet or not. CV had the phone, they
recognized by my phone number that there was a prescription in the works and they said no, it’s not. I didn’t have to talk to
anybody, I got my answer. And that was a, you know, better and more efficient experience for both myself and I
certainly didn’t need to use the time of a pharmacist. And so it’s recognizing identifying ways that can automate the low value tasks, therefore, reserving the time that can be better spent for pharmacist to provide one on one counseling, if I have a question
about my prescription, as opposed to, if it’s ready or not. – So Jen, you brought
up some great examples. In this, you know, let’s shift to, you know, we’re getting
a number of questions which are essentially who’s going to pay for this stuff? – [Jen] Yeah. – And you mentioned the payer. How we’re payers viewing this? Now, let me also bring this up in the context of this summer. We finally started seeing some IPOs from digital health companies or at least companies
that define themselves as digital health companies, and their post IPO value is
in the billions of dollars. So Jen, let’s start with you, but let’s open it up to everybody. How is it that we’re
justifying the business model? Who’s paying this? And how is proper? – Yeah, so again this is right now, the heart of the questions
that are being asked as you know, digital health evolves into digital therapeutics and these digital therapeutics go from one man startup
to thriving businesses, it’s, you know, how do
you monetize the offering? And, you know, right now, the models that I’m seeing in place, I mean clearly, there’s the
easy direct to consumer, the consumer pays for it, whether it’s you know, through an app or some
subscription service. But, you know, the other types of models are actually partnering
with a benefits consultant, getting into the self insured space. These employers, large employers who are absolutely looking for ways to not only keep their employees happy but reduce what they spend. That they are making, on
behalf of their employees, for health care expenditures. And then the final piece, is your payers are starting to recognize that this is not only an offering that could potentially
reduce medical spent, you know, when these types of therapeutics are effective by all different outcomes, but also could keep
their constituents happy, you know, because I would say if you look at the NPS scores of pretty much any major insurer, they’re probably not the highest and it’s a how can payers
use innovative models to bring forth solutions
that their members might want and benefit from. And also then have reduced
costs within their plan. And so what I’m seeing is that, your digital therapeutics companies are partnering with these insurers on value based models where it’s once there is a
proven reduction and whatever, proven outcome delivered, so whether it’s reduction
of medication spent or, you know, XYZ days, you
know better quality of life or whatever the claim is, once that is achieved, then the financials are tied to that, as opposed to a 29.95 per month. – Sri you’re focused on the bottom line as a VC, I can imagine. What business models resonate with you when you’re looking at startups? – Well, the key question that we ask is the same thing that we actually asked at one of the SOM classes here and GT 657, and actually asked in your class too, which is, who pays? And how okay is it, such an odd beast compared to many of the other industry as to the, who pays, seems to be not the person who actually ends up getting the ultimate benefit, right? And so for me, when I think about it from a VC perspective, we’re looking to see where
are the multiple sources of revenue coming into the company. I want to see things,
I want to see companies that are saying well we’re
going to get some revenue from the consumers because
it’s a subscription model or premium model, or I’m going to get some
money from the employers because we can improve outcomes for them. I’m going to get some money
from ad sales and marketing ’cause I’m able to, sort of, recommend appropriate
products for consumer, so that the cost of providing this service or the care is not locked
to one single entity, right? And that’s kind of what I’m looking at. And when we look at products right now. Very rarely do we find companies that are very successful in just doing one source of payment, isn’t working. You pretty much have to spread, where your income streams are coming in. Because it also functions on the size, of the size and the scale
of that digital company. If your digital company just focuses, let’s say in New Haven, you have a very different strategy, than a digital company that’s focused on all of North America. Next we ask the question about language and Mexico and different payment models. So how do we have to think about that? Most of the portfolio, of all the portfolio companies we investment in are global. So, the payment question
is absolutely critical because it is very different around the world, you know. Whether it’s government pay or private pay or insurance here. So we have to go to the
lightning round and wrap up. (Jen chuckles) Your niece or nephew
comes up to you and says, Uncle Rob, Uncle Sri, Aunt Jen, why should I be excited about health care in the future when I grow up? Let’s start with Rob,
let’s start with you. – It’s all, there’s always
going to be a need for it. We’re all patients to some degree and I think we’re just
scratching the surface at how technology, in the
theme of this meeting, how technology can empower patients. I mean the end goal is
that allow patients and us to live healthier, happier better lives, and so there’s enormous opportunity. And we’re just at the tip,
tip, tip of the iceberg. – Healthy, happy, all right. It’s only starting, Uncle Sri, why should I be excited about healthcare and technology in the future? – Because you’re going
to live to be at least, one in three each child born today is going to live to be at least 100. So you’re going to make it to at least 100, 120, 140. Healthcare is just going to be something that you need to pay for and hopefully you can figure it out so I can live longer as well. – Are we improving access? – I think it’s going to
become, I advocate it. – Okay, all right, Jen, Aunt Jen? Why should we be excited? – I would say, because, unlike in the past where you had to be an actual physician and go through years and years
of very specific training to actually impact
healthcare for a human being. You niece, whoever, you
now have the opportunity to improve someone’s life directly through all different types of ways. Whether it’s through, you
know, content engagement or social media strategy. You can change someone’s
life through healthcare, in a way that was never before possible. – What a wonderful way to end. Thank you everybody that I think, brought us to the real
definition of empowerment of healthcare consumers by technology. By making everyone’s life better and getting more engaged with healthcare, using all these tools. So I agree, I think there’s
a lot to be excited about. And very grateful for
this wonderful panel. Very grateful to be part
of this very educational and fun nice discussion. Thanks very much, everybody. – [Jen] Bye guys. – [Rob] Thank you.

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