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Digital Marketing Tips to Help Your Organization Increase Sales, Attract Talent and Win Mindshare with Gary Monk, Healthcare Innovation Consultant

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

: I thank you for tuning into the podcast again. I really appreciate that. You know I've gotten a lot of information, a lot of e-mails saying how certain episodes have resonated so don't be shy follow up with us on Twitter at @outcomesrocket, we'd like to hear from our listeners because today I have an amazing guest and I also invite you to rate and review us at outcomesrocket.health/reviews. This guest is an amazing collaborator in health care- a digital healthcare innovator with over two decades of experience. Originally from London, England. But now here in the United States specifically in New York City. His focus is on helping healthcare institutions differentiate themselves through innovative strategies using digital and also technology and so his focus is social media. Its digital platforms for marketing, anything that will help you as a healthcare professional as a healthcare leader within an organization. Promote what you're doing but also get it to the right hands at the right time. So Gary just want to welcome you to the podcast and fill many of the other gaps of that introduction that I may have missed yet.

: So I think that's great, that was that was all good. I should say I moved over from London to New York several years ago. I'm actually originally from Birmingham so I don't want to forget my roots. That's from I'm originally from the UK but I spent many years living in London and I've worked over that at that time in healthcare. Worked within pharmaceutical companies a lot of Simon Johnson Johnson and then working in agency and consultancy. So a broad broad experience but I think you covered it very well. So yes looking forward to this.

: Absolutely. And so are we. So the reason why I wanted to bring Gary on here is to get a little taste of outside of the normal health care box right because in general we've got to find better ways to target our customers our patients and really get a better outreach. And I think we all struggle at this. And so Gary is here to provide us some insights. But before we do get into that Gary what got you in the healthcare to begin with?

: Yeah I mean I'm a real science nerd so my study I guess you'd call a major here and majored in organic chemistry and medicinal chemistry. Yeah and I was really fascinated with how these humans build molecules can interact with the body receptors at these sites and have a profound sense of profound positive effect but also how we could minimize side effects and make sure they were really specific. So it's I found that side of it is fascinating so that got me into healthcare and interested in pharmaceuticals and also the scientific pursuit of it, very exciting but also that potential for doing something good for humanity was compelling. So that's got me into it. I spent some time in the lab. One small anecdote probably in my life I definitely have got the skills for science but in terms of the humbling part of that is I certainly did not have the practical skills because at my time at the Glaxo research center in England I was working in the hydrogenation suite there and Trott's and finely divided catalyst on the floor, started a small fire really created the next small fire has to be the catalyst kind of expose the air and set on fire. So luckily we didn't end up with the next Hindenburg but I kind of realized I have in mind for science that maybe not the body and the practicality and the coordination but that got me in there and then I moved out of the lab and the rest is kind of history really.

: But that's awesome I'm nothing terrible came out of that Gary but your passion stuck and now you're helping people build fires so that they can get attention to their practices and businesses so you're doing it in a positive way.

: Exactly, a lot that's Yes that's true.

: So that's fascinating. What would you say today Gary is a hot topic that needs to be on every medical leaders agenda and how are you guys approaching this?

: Yeah the thing I think of is data an artificial intelligence sounds like two topics but clearly they're very deeply intertwined. And when I say data I'm talking specifically about personal and patient data and they kind of like sound like dirty words now particularly with the times with what's going on with Facebook. But we got these initiatives going on around real world data, population health, outcomes driven health care lot of those was but important initiatives. But none of these are actually going to produce anything of value without the right use of data. The right approach and the use of artificial intelligence for example in artificial intelligence is will highlight we can set up a program, say Population Health Program. Artificial intelligence is going to actually highlight factors that the researchers program managers have not even considered in the set-up page and really help us join the dots in the ways we might find it hard to do. So say yes that's very big and it's a complex challenge. So when I think about my approach and our approach to that one, thing that comes out is very specific. Clearly we need to get all the set up right about understand the problem make sure asking the right questions. But what I would say is probably actually more of a general point that could apply to other things outside of artificial intelligence as well but is to really think broadly in the thinking in the ideation phase. So to give you an example in most cases pretty much all cases you want to go super broad in terms of the types of data collection. But let's take a hypothetical example if we're running a program in New York around mental health and we're trying to support patients who may be on medicines but we've got a coaching program on online coaching counseling program support program that they can go to. Obviously we can pull a lot of metrics of how patients are engaging but we probably want to take as much information about that patients as possible and those patients to feed into the system. So what I'm talking about the ideation phase is when the planning that is to really look at the types of datas that would be useful to us. And look at them without judgment. So conceivably we could think for those patients that would be great to you know where they are, whether they're going out, use a geolocation on that phone, how active they are, how much exercise they're doing, any activity based from their phone. Any wearable devices they are using, if they got a sensors in their home measure their exact movements, monitor their phone calls, a number of phone calls, frequency duration of calls. Same with text messages how long they are and even what they are saying from their voice modulation intonation to actually what they're saying. The more I can't keep saying it probably sounds very very creepy. But the important point I'd want make in it, yeah.

: In the back of my mind I'm like holy cow. Like that's a lot of information and it makes you think right like we could get a lot of information from our cell phones. So how do we use it. What are some guidelines there and what are some examples of what you guys have done.

: Yes. So there's a lot of good examples of that. I mean this one I wasn't directly involved in but I think it's a nice example one that I'm actually involved in kind of sharing out, blocking around it. It's a little while ago now. I think the company slightly pivoted but a company called Ginger.io. So I've actually pulled that into proposals, the clients, the pictures has been actually build it out but that was fascinating technology where they actually use the mobile phone I believe they use the tracking of the phones of the geolocation, and the sensors, the patient moving around as a proxy for how their depression was going so clearly if they're sitting around they're not moving much generally that probably moves probably lower if they're functional moving around, going to the shops, going going out, seeing friends, socializing that's obviously good. And I mention a bit about voice to kind of throw that in there. But actually I believe they using not going as far as monitoring what the patients were are actually saying which I appreciate sounds creepy but understanding their voice modulation. So how often they are speaking. So actually, now okay, if they're isolated and they're not sending text messages, they're not calling their family, they're probably not in a good place. But if they're making frequent calls you know we're not interested in what they're saying, snooping on the conversations but actually if having those conversations on a regular basis, it's probably a good thing. So using those metrics. So I think that's a really good a good good use case all. The reason I put this about listening to the patients in there, it's kind of to be provocative. But I think it's a really important point when we start thinking big on these projects. There's no harm in thinking these things initially, I feel the problem I'm kind of going on a ramp here now. But I found a problem with big companies as opposed to start, having work in both will shot down ideas like next lessons what the patients are saying.

: Right

: Explore that and we might get to a point of actually ethically that doesn't work, it doesn't work for the patient. But let's explore where that could lead to and maybe it leads to the point of actually we listen to the patients conversations. Not what they saying but how often are they saying it, the voice modulation that we anonymize everything, they identify everything. So we get to kind of an exciting place because we've opened our thinking rather than someone then say a farmer of a big biotech company. No we can't do that, we can't listen to what's patients are saying over the phone and it kind of gets shot down as soon as it's thought about and conceived and then the end idea often ends up very vanilla and really not that valuable. So you see what I'm saying.

: I totally agree.

: Thinking big initially. Yeah, and then we pull it back in and we make sure we're doing the right thing on the patient ethically and we don't go spying on patients et cetera. We start thinking what data could we actually use and how would we get it and how would it serve us.

: Yeah. Gary, and you bring up a good point, right? The point here is listeners you've got to be open-minded if you're going to innovate, you've got to be open minded and sure, it might be a little edgy but let's find ways like anonymizing and de-identifying and stripping away the things that are patient information and making those voice markers or key keywords something that could serve the people that it's intended to serve. And Gary the thing that brings up kind of thought in my mind about this discussion is the whole area of digital therapeutics and what's being done with digital technology to help patients. It's super interesting what's going on out there isn't it?

: Yeah absolutely, absolutely. And you know obviously what you said I can cover a lot of things but it's simply fascinating when you've got digital tools that can even, that actually help patients. I was speaking to a friend who works for a startup and I say what he does as a digital therapeutics but actually helping patients sleep better. So analyzing understanding their sleep patterns by sensors on the body but also in the room where they're sleeping. And then part of the digital therapeutics is actually adjusting their environment, the temperature of the room but also the important thing that he's doing is actually using research to actually place specific segments of white noise at certain times when patients are sleeping, deep sleeping, their having their delta waves of deep sleep and the scientific research shows when the right sound is played at that time it can actually extend the period of deep sleep.

: Fascinating.

: And mean, the patient, the human being gets a lot more restful sleep. So I would say that's a good example of a digital intervention where it's listening, understanding but also giving that kind of response via feedback and there's a good patient outcome hopefully at the end of that.

: Gary what a great example and programs like video games to help you with ADHD instead of Ritalin. Listeners,the point here is what Gary is telling us is that we've got to think outside the box and we've got to push the envelope and oftentimes large organizations get trapped with the knee-jerk 'No'. And the little guys come up the little digital Davids and they kick butt. And so just a little thing to consider this little warning like be open to innovation and be open to ideas even though up front they may not seem like it distill them to the point where you can actually maybe get something that's not vanilla to Gary's point and it doesn't make an impact. So Gary can you give the listeners an example of some of the things that you've done to help your clients create results and get things done better improve outcomes?

: Yeah, I got a couple of examples. One thing is coming to mind that I've been working on quite extensively recently which is a hot topic is a social media. So I can't get to many specific examples but I've worked on clinical trial recruitment using social media which is very exciting because we've been able to get patients to enroll to play with trials faster than they normally would. And also more of them faster but also importantly at a lower cost as well. The cost of acquisition is between 10 and 100 times lower than using traditional methods. So that's been very exciting using social media for that. I even shared something yesterday I wasn't involved in it but the use of artificial intelligence attached to medical records to recruit patients for a clinical trials, that's how it's kind of evolving, that's such a big a big area where there such potential to help patients that there's a global shortage of clinical trial patients and also ensure that done cost effectively as well. So that's the big thing. I kind of broaden out to social media generally again because it is such a hot topic. So I've been working on, I mean I love social media from the perspective that using things that Facebook, you can target patients directly and actually understand whether they've taken specific actions seen adopt the measure if they've moved on that journey towards better outcomes. And the reason I mention Facebook sub-16 in the news a lot recently Zuckerberg been hold up in Congress. But yeah, it's very it's got a lot of good potential within healthcare but obviously it's got the potential for misuse as well so that I'm optimistic we can get to a point where the goodwill will triumph and we can use it but I'm just really concerned that the people don't get the point of like Facebook using this is bad, start using it. There's a lot of good that can actually be done if it's done in the right way using using this and other other channels.

: Now totally man and you know Gary let's talk about Facebook. So a lot of folks in the industry will think about campaigns whether it be driving patients to a trial, medication trial whether it be a training business clients in the healthcare space. I've heard the debate Facebook versus LinkedIn, which one is more effective. What's your take on that?

: Yeah I mean I've got a lot of experience doing this and obviously it does depend a lot on who you're targeting and exact and what you're doing. Overall, forget about the audience in terms of the power of the targeting. Currently Facebook I know they're pulling back some of that based on you know some of the abuses that they've had. So we'll have to see how that nets out but it still looks like the targetings would say a lot more powerful than LinkedIn so from a fuel targeting perspective, I find Facebook more valuable. In terms of treating patients in most cases Facebook is going to be where more of the patients are and easier to reach in context. Obviously a number of them maybe on LinkedIn, but in terms of actually reaching them the right way around that condition it's usually accepted more for that message to come through something like Facebook than LinkedIn. The work I've done targeting health care professionals actually it's been a mix of, I've had mixed results depending on the type, the type of project, the type of physicians working on LinkedIn versus Facebook. Often my advice would be, you know without knowing more about a specific project, if it's healthcare professionals, look at doing both and then see what's really working. Why are you getting the most benefit, you the getting the most reach and then send over the, leave the budget on to one that's working. So I'd always advise clients to be flexible. You have got this pot of money. We decided we're going to put like, play safe part on LinkedIn, half on Facebook but we have to quickly dial it up one way or the other if we're getting impact one one platform versus the other.

: So overall you feel like Facebook allows you to do more acute targeting meaning more specific targeting and LinkeIn not as much but you recommend sort of try a mix of both measuring and then pivoting once you figure out what's working out.

: Yeah absolutely. And what surprised me from practical expense is how effective Facebook can be about reaching doctors because you know you see the statistics a lot of doctors are using Facebook for personal reasons.

: Right.

: But a lot less using it for professional reasons. But that's kind of a bit of an arbitrary distinction because when a physician is on that for personal reasons, if someone is coming out in context the doctor's not going to switch off that it's relevant to them or their practice. So they're still going to click through on that ad if they're using it to keep in touch with their family or look at their friend's holiday pictures they're not going to ignore it and say oh I'm not clicking on that even if it's interesting and relating to my profession. Now that's not going to happen, they're going to they're going to click on it. So yes, definitely consider Facebook for doctors.

: Fascinating. Now that's some really great insights. And listeners as you consider these newer digital platforms you know take some of these thoughts from Gary and plug them into your strategy and do some testing as you work to reach those people that you want to impact most whether it be patients whether it be providers or industry. Just do these tests and ultimately the end result will come from being able to tweak, tweak until you get the result that you're looking for. Gary what would you say one of your proudest leadership moments in healthcare have been today?

: Yeah. So that's a tough question, there's a lot of work I've done. But yes but the one thing that's coming to mind that kind of leaves lodged in my memory because I kind of built on it since was a couple years ago I led a team hackathon in Cleveland Clinic.

: Nice.

: Yeah it was great, it's very exciting and we created a solution to potentially helps chronic pain patients reduce their dependence on opioids at new stage or not artifitially intelligence to learn what interventions were having an impact outside of the medication. So even things like kind of acupuncture, yoga, meditation. So there's a great achievement by full disclosure on that, it won an award at a hackathon which was great so it was successful from that perspective Due to array of reasons didn't get that built out. I'd still love to build that out. So I think that's extremely exciting but the real positive from that and I'm proud of it is the learning of thinking from Math is there. I have been able to move that on into other projects, advising startups, biotech pharma companies on similar projects. You know if you examine the field of mental health. So it's taking that value even though not directly in that project and using that knowledge in other projects. I think the reason I'm proud of that and those type of projects is you know I really believe in what pharmaceutical companies can do. What I also believe in is the importance of having that kind of a holistic approach of what's working for the patients. Sometimes drugs are great sometimes they are not right great. Sometimes they are very important in the context of other interventions. So that's really important for me is having the right interventions for the patients that may or may not include drugs but we're not just totally focused on the early onset is a pilland a medicine so you know that's kind of where my head is with that.

: Yeah that's really interesting Gary and thanks for sharing that I know a good percentage of the of the listeners are also entrepreneurs building things. And so if what Gary mentioned to you sounds interesting. By all means at the end of the podcast Gary will share his contact information how you could get a hold of them. Maybe it's a project that you and Gary can pick up, dust it off and get it going because there's definitely a need for solutions to solve the opioid epidemic. And so the imitation is there, right Gary?

: Yes absolutely. I'd love to keep working on that. Definitely.

: Tell us a little bit about an exciting project that you're working on today?

So, I'm working on as I said those types of projects there where I'm working on actually using real world data to support patients from various different devices. It's hard to talk like exact specifics but to give you an idea of some of the range of stuff I do something important is working on a number of digital transformations for mainly pharmaceutical companies which is really moving them from a position of not using much in the way of digital channels and communications to their patients and their doctors in their in their marketing. Actually using it in a really defined smart way in a way I don't even want to say multichannel but in a way that really understands the needs of the end customers and actually takes them on the journey and the digital tools they use in the right way and that's exciting for me because that's measurable using digital and technology to take whether it's doctors patients on a specific journey and get to an endpoint. And the beauty of that measurable pace is we can really tie that back to outcomes rather of the the easy way of doing things it's like we need to be digital, let's do e-mail, like Websites that builds an app and just kind of throw things at the patient not the doctor. There's a fair chance that's not to work anyway. But if it does work we kind of don't even understand what's really working and what's not. So some of those transformation projects you know for me are very exciting. And then the more those some of those projects working on building in the technology were actually supporting patients not just using medicines but actually using technologies and other interventions so those ones but those are the ones that I find even more exciting.

: Super exciting and you know we need more of that Gary, so keep up the awesome work there. There's no doubt that companies are starting to come to grips with the fact that this is the way that things are going so keep up the great work.

: Great.

: So Gary getting to the end here let's pretend you and I are building a leadership course in medicine, the Digital Leadership Course in Medicine, the 101 of Gary Monk and I want to build out a syllabus with you. I've got four questions that our lightning round style so some quick responses to these followed by a book and a podcast that you recommend to the listeners. You ready?

: Yes great.

: All right. What's the best way to improve health outcomes using digital?

: So the key thing is understand the patient's situation. I know you wanted it sure but that probably sounds like a cliche, really challenge what you know about the patient and observe the patient understand that pain points. I always like to think if you were if you wanted to understand how a lion lions hunt you don't go and watch and see to the zoo. So forget focus groups just really observe the patient and understand them.

: Great analogy. What's the biggest mistake or pitfall to avoid?

: The key thing to me is we need to stop by asking the right questions. So yes I mentioned dates you and I are important. But if we're not careful we might start to get the right answers to the wrong questions.

: How do you stay relevant despite constant change?

: The two big things I've mentioned the focus of the patients are really understanding them as they evolve but also involving the changing technology landscape so involved both. Get both reported, the patients actually more so because if we understand the patients and not the technology well enough the outcomes are going to be sub-optimal. If we understand the technology and not the patient, it's going to be a disaster.

: Love it. What's one area of focus should drive everything in a health organization, a digital area of focus.

: A digital area focus. So I was going to just answer the easy thing which is important and bring it back to the patients. But actually if you saw a digital area of focus it's understanding that patient, the patients not to see things out necessarily digital, non-digital but just really understanding what they're using, what channels they are using but also why are they using them, what problem are they actually trying to solve with that so just getting real deep in understanding that from a patient's perspective.

: Outstanding. What book and what podcasts would you recommend to the listeners, Gary?

: Yes. So in terms of a book. I finished a recent book actually called Life 3.0 by Max Tegmark and it's about the future of the artificial general intelligence now the some healthcare examples. But what I love about it is it really takes the future forward about where artificial general intelligence can go when machines get smarter than humans. And before I read think more about science fiction. But actually this stuff will be a reality it's just a question if it's whether it's 30 years or 300 years from now. I mean that's what the experts are debating, not whether machines will get smarter than humans but just will it be hundreds of years away that we have think about it in our lifetimes or could it be sooner. But actually it was really good. So understand that from a kind of visionary perspective and then to tie things back from healthcare and understand where it can go.

: Life 3.0. And how about a podcast?

: Yeah. So I feel like your questions I'm comfortable with them all but this one's kind of stomp me you, know I listen to a range of podcasts like not including yours, but I'm just starting to really get into them because you know I've mentioned that book Life 3.0 and it was the first book that I listened to on Audible. So yes, I've found that now in New York when I'm I've got so much time to kind of more like listening to stuff and reading stuff you know when I'm on the subway it's a lot easier to listen than to read so probably next time I'll have a list of cast but really anything to do with technology so I dip into any podcast-related technology. I have listened to digital marketer, once on digital marketing, such really keep up to speed on digital social media and technology so I kind of dip in but also it's a recommendations from you and your listeners as well apart from this podcast and the others I should be listening to so yeah.

: Outstanding Yeah. And now sinner's that's the beauty of podcasting. You know you could go into the podcast app type in your topic of choice whether it be health care or if you want to just take a breather from health care and learn about tennis or cooking or marketing whatever you want. It's all there. The platform is powerful. So do like Gary does you know search for what you're feeling in the moment and just go for it. Gary, before we conclude I'd love if you could just share a closing thought and then the best place for the listeners can get a hold of you.

: Great. Yeah, I mean the closing thought really would be that the one thing that we discussed that kind of that I feel the most strongly about is just that real you know without you know not wanting to sound like a cliché but thinking big and by that is like just really fearlessly going out thinking about what you need to do to achieve the specific outcome without judgment and criticism. And you know I've read the Debono book many times and it's kind of that green up thinking where I'm judged, not you are creative, we're not judging. And then we bring in the critical thinking later about what the current issues to regulator issues might be. So to think big and open it first would be the really big change to make this stuff happen and don't let me off thinking initially. So that's be the really the big thing to me and yet I'd love love if the listeners want to get hold of me, that would be great. I'm very easy to find on LinkedIn. And I'm very open to connecting so you can put all the extension into LinkedIn and it's Gary W. Monk would just search for Gary W. Monks that's one 'r', search for me their own LinkedIn and switchapp, it's just simply @GaryMonk,so that's where the two best places to find me and I'd love to connect.

: If you're on the road don't worry about writing anything down just go to outcomesrocket.health/monk and you'll be able to find all of Gary's information, links to the books that he recommended and a transcript of today's conversation. So Gary, just want to say thanks again for spending time with us and looking forward to staying in touch.

: Yes definitely a pleasure. Thanks all and looking forward

Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is "implementation is innovation". Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book and Podcast:

Life 3.0: Being Human in the Age of Artificial Intelligence

Best Way to Contact Gary:

LinkedIn:  Gary W. Monk

Switchapp:  @GaryMonk

Mentioned Link/s:

https://ginger.io/

Episode Sponsor:

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The World's First FDA Cleared Wrist Pulse Ox Sensor with Leon Eisen, Founder & CEO at Oxitone Medical

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

: Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring healthcare leaders. I really want to thank you for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's program because we have an amazing guest for you today. His name is Leon Eisen and he's a Ph.D. inventor, entrepreneur and contributor to healthcare. He is most recently well known for the formation of Oxitone Medical where they invented the world's first FDA cleared risk sensor blood oxygen monitor without a bulky fingertip probe to meet the basic health care needs. Keeping people healthy or at home by providing hospital grade digital continuous care with AI capabilities. We're going to be diving into some of the things that went into that and the thought processes of how this could improve health care are a little bit later. But what I wanted to do is offer Leon the opportunity to fill in any of the gaps of the introduction. He is coming to us recording from Israel so a big thanks for jumping on with the time difference Leon. Welcome to the podcast and tell us a little bit more that you want the guests to know about you.

: Thank you much. I think you'll said a lot about me even more that I could say about myself.

: It's a pleasure. It's a pleasure Leon. There's no doubt you've done a lot in technology and also in medicine and I love to get a better understanding of what got you into medicine to begin with.

: Oh it's interesting. After I graduated from PHD, I went to post doctorate research one of my friends just asked me to help with optical design of new redesigned sensor.

: Yes.

: Device. And today this device is in the market by the way it's the only device on the market to measure hemoglobin. And I said okay, I can help you. So this way I get involved into a very interesting, very promising and very important for all of us healthcare business, technological business, technology business. So I was so much excited about doing and the building medical devices so I left my post doctorate research and joined this company. So I joined another company and another company like executive then my father just go out on the street being free hours discharge from the hospital.

: My goodness.

: I called our physician and ask him, so what happened? Why?

: Yeah.

: He said I don't know. I saw him three hours ago. He was great. I don't have any capabilities to check what happens in real time. So it will sound someone came it took 15 minutes to make some trash to measure all this stuff. Thank God, my father was still alive. But this was my humbling. So I have all capabilities, all knowledge even technology in my hands which I can use to monitor patient continuously did what happened before. Why can we monitor oil, engine, but why we cannot monitor continuously human being?

: Totally agree. That's a great point.

: So we decided to do something that's impossible. We decided to move graph, decided to start up oxygen sensors from fingertips to the reef. So this way it becomes very comfortable. It allows us to measure 24/7 and just we left the state we have about 2 middle patients under continues oxygen administration. That's really where fingertip device is 24/7 impossible to look to their fingers how they look like. So we decided to solve this problem before. So we are first on the market. Many, many companies just entered into this area. They decided to like Wombles for example failed to measure what pressure, glucose has always maintained patents to allow nothing except it. Will that work for us wireless sensors for oxygen monitoring, FDA cleared and by the way you take Apple with all noise around apple health care. There are no medical devices. You know oxitone is a world first FDA cleared medical device which measure pulse, rate, or medical grade.

: And when did you guys get your FDA approval Leon?

: But with did very complicated clinical trials in Colorado only two sites in the United States where you can make this iteration tests. Here are can come comparative test invasi oximeters.

: Yes.

: Like my Seema like any medical like all other devices today fingertip devices.

: Yes.

: The unit is just trial deals they didn't believe because they said many companies came to us, it doesn't work. We succeeded they checked it many times. And finally they said OK, it works. This is where technology, so this is literally technology without more than 5 portals ground paternalistic knowledge world wide and we're using very unique ways, unique configuration of sensors that nobody could repeat it.

: Congratulations on the approval. When did it happen.

: Exactly a year ago. By the way today I have my birthday.

: Today is your birthday?

: Yep.

: Happy birthday.

: Thank you very much. Exactly at my birthday a year ago. We got FDA clearance.

: Did you really? Talk about an amazing birthday gift. That's amazing. That is amazing. So big congratulations to you Leon. It's not easy to get approval especially on a device that others have tried to develop and have failed and so a year ago you got approval. What are you guys planning to do now?

: We've planned this year on developing sales infrastructure. Because it's not just sale like other devices for atmospheric measurements. It requires some technical support. It requires continuous connection to the healthcare environment. We've developed finalized with portal patient or the patient application because I can't even tell you that some companies they are not ready to take wire to catch up this. It's such such a huge stream of data. They are all dedicated to omcethey are once we mainstream and by the way all these measurements you post when they feel that, they get measurement. In our case will whole digital continuous care. While the US entry into the digital continuous care. And what is the difference? The difference that each should have continuous care yoi have produce.

: Yes.

: A lot of evidence base. So if you a once a day once a week, you cannot predict anything but it does have some impact on vital signs. And by the way we measure what oxygen saturation holds the rate activities, temperature, pulse rate variability so it's against stress. So we have the department continues potom of data. So if something changes, it's a blueprint or a patient like they may. And this is will be catch up in time.

: It's definitely exciting. And so you're putting together the infrastructure you're putting together the platforms for for patient portals connectivity to help others do the digital continuous monitoring and definitely exciting for this technology to come forth. For you, Leon what would you say the future looks like? Let's call it five years from now. Where is this technology being used? How is it being implemented and who cares about it?

: Very very difficult question because this creation belongs to resistance of the current medical system to new development of design and I think in any it's importance for high risk patients.

: Yes

: So the main important use case is the high risk patients recently discharged from the hospital. All we talk about hospital at home. So patient in stable going to the hospital to be admitted after the emergency room visits. They could be sent back home with the same level of hospital grade monitoring like they would have in the hospital. So I think at least acknowledge it. And by the way there are other companies like wide to come that they also they provide the digital continuous care or heg from that patch. Maybe she's not so comfortable like a small wrist watch made case it was. So there is some cohort of companies we should just write to all the right who the market with their medical system to accept our technology. Digital continuous not only monitoring because it's a digital continuous care. This is the hospital great care at home. So I see them move using these technology. We can move hospital care and monitoring to the home so we can remove or reviews hospital stay very dramatically because instead of whether we have to spend two days in the hospital just for measurements of vital signs I can pull up that they take off my small fingers to monitor. Everybody knows what to do and take oxitone, go home and continue the same level of care of monitoring. So we have three main changes that will happen and our technology will intensifie just readmission reduction, very low readmission and very low, very efficient readmission because all readmissions reduction to date has been very high new workload it's very high, very costly. In our case, everything happen automatically. So you have automated continuous door at the same time. You don't have to call every day to check the patient, to care to go to the patient every day, to ask what happened. Everything goes automatically up while you're waiting for that a lot. And a lot of cell will be before something happens. The other emergency room to hold. And then our water or another change it will be a real reduction. Will the hospital stay.

: Well there's no doubt this technology will be providing a lot of benefits to patients to health systems potentially a big way to reduce costs. Right getting patients home faster and it's pretty exciting. Now maybe something that I'd love to hear from you Leon as the listeners also are working to bring forth their innovations. What would you share of a setback that you had in the long process to get this technology finally approved? Can you share a setback or a failure that you experienced and what you learned from that?

: Well you do something new. You go through a hole pitfalls you can find it. So.

: Yes a lot of pitfalls.

: Doesn't allow the easy way, you know so if you have some pitfalls you will get in. So yes it is the real problem. Somebody said if it doesn't kill us, it make us stronger. So really we investigated each mistake. It was a mechanical mistake it was technical, it was optical, so everywhere. So we made a very small step then stepped back, step fast, step back. So we systemised all these mistakes, we build working system, working system I would say and this allows today to anticipate some mistakes and to avoid it.

: Fascinating. And so there's no doubt Leon, you're a patient man.

: Not sure.

: You're a patient man with the vision. Right. And so folks if you're listening to this you know it wasn't an easy road for Leon to get to where he is now with him and his team finally having an FDA approved product and building systems to actually commercialize and distribute this product. It's Pptients. It's a vision. But to Leon's point it's also building the systems that are going to help you avoid the failures and the setbacks that you had to begin with. And so Leon really appreciate that share. What would you say today is your proudest medical leadership experiences that you've had?

: I think I can just separate leadership, medical or executive or I don't know. So just have to move. We have to move all the time. We can't just watch what happens. Dawn Oh I do not have to move all the time and the leadership experience that once I stop, I lost a lot. Never stop it doesn't matter do we have money, do have customers. If you believe in what you're doing all of the world will follow you.

: I love it. And this is such a great message. Leon I last week I had a chance to be at the Beckers healthcare meeting where I was able to hear both President Clinton and also President George W. Bush speak and they shared the same message and that message was stand for something, believe in something and stand for it and do something. So coming from two past presidents and also Dr. Leon Eisen I think it's piece of advice worth following. Listeners stand for something and do something and the world will follow you. Yeah very great share Leon. Very Great share. Tell us a little bit more about an exciting project within what you're doing now that you're so excited about and you want to tell the listeners.

: This is still the same project to have to improve our device. And the more vital signs with and more capabilities and the most important we're going to launch sales this summer. Official sales.

: Awesome

: Even from our website we have a long list of preorders. just from patients, from physicians, from institutes, universities and companies. And so our project today is to launch sale...

: So being that it's an FDA cleared device. Do you need a prescription to have it or can patients buy it directly. How does that work?

: Because you have 5000 K we need a prescription.

: So you do need a prescription, nevertheless it's available. Once you have that prescription patients could buy it for themselves.

: They could buy for themselves or insurance companies to provide, hospitals who provide them who tried different business models. Because again you don't have very well established business model yet though. So why. Because for example any proximeter is not induced by Medicaid or Medicare. It was reduced because while you do more so so be the whole use all at once a week measurements will pay for that. In our case another challenge would have to show that there is the real Weidensaul, we bring medical device or medical device in different level and we have to the reason why in this device and we have to get in there. And this is another project we are just getting started working on.

: Excellent. Well we definitely wish you the best on this on this project. I mean you've been persistent even passionate and you've been consistent in your approach and I have no doubt you're going to succeed at this Leon. Now let's pretend you and I are building a leadership course on how to be successful in health care leadership. It's the 101 of the Dr. Leon Eisen. So we've got a syllabus. We're going to put it together four questions that are fast, lightning round questions followed by your favorite book that you recommend to the listeners. You ready.

: Yup.

: Alright. What's the best way to improve health care outcomes?

: To get patients involved.

: What's the biggest mistake or pitfall to avoid?

: To accept industry resistance as no.

: How do you stay relevant as an organization despite the change?

: The whole world is changing.

: And finally what's one area of focus that should drive everything in a health organization?

: In our organization it's device.

: What book would you recommend to the listeners, Leon?

: I recommend Art of War by Sun Tzu. This book, I read every once a year. I read it again and again. I don't know, like bible. And every time it gives me inspiration and understanding how to fight.

: That's wonderful. The Art of War and listeners. Don't worry about writing any of this down. You could find the show notes as well as links to all the things that we've talked about including links to Leon's company Oxitone medical as well as the link to the book that he just recommended and a full transcript of our conversation. Just go to outcomesrocket.health/oxitone. You're going to be able to find all that there. Leon this has been a lot of fun. Really excited for the innovative approaches that you guys are taking. If you can just share a closing thought with the listeners and then the best place where they could get in touch with you to learn more.

: Here's to follow. I very much appreciate our listeners for their time. So thank you very much. And what I suggest first of all, move all the time. Do not stop, if you have an idea, you have to start to elaborate this idea. I called business you around this idea so I'm open to any questions if you have something - starting from zero. Do something personal. I'm here for you.

: Outstanding and Leon, really appreciate you spending time with us and looking forward to seeing your success and you to add value to the health system with this innovative technology. Thank you very much.

Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is "implementation is innovation". Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book:

The Art of War

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How to Increase Engagement with Chronic Condition Patients with Cory Kidd, CEO at Catalia Health

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

: I really thank you for tuning in again and I welcome you to go to our outcomesrocket.health/reviews where you could rate and review today's show because we have an amazing guest for you today. He is an amazing person, super smart and a great contributor to Health Care. His name is Cory Kidd. He's the CEO at Catalia health. His background involves over 20 years of health and technology half of which was academia at the MIT group in the Media Arts and Sciences Lab as well as just being at the frontlines in business and so he's got such a great mix of experience in both of those and now with his new venture at Catalia health. I thought it would be wonderful to get him on talk to us a little bit about robotics, artificial intelligence and the beautiful amazing things that they're doing at Catalia. So Cory, welcome to the podcast fill in any of the gaps there that I may have missed.

: Well first thanks for having me. It's great to be here. I think that was a great overview of it just to kind of ground the conversation. Yeah. Quickly My background is a mix of number of different things an undergrad of computer science focused on artificial intelligence and human computer interaction all applied to healthcare. That was a Georgia Tech and that was at MIT as you said I did my Master's Ph.D. at the Media Lab, spent a few years at Boston University Medical Center in Endocrinology and observing and getting to spend time in the clinic seeing patients. End of the last decade, I've started a couple of companies commercializing some of the things that I found during that academic period. But the overall arc has been how can we leverage cutting edge technology to solve some of the big challenges in healthcare.

: Beautiful and so no doubt Cory that you have a rich level of experience across a lot of different areas and so just out of curiosity What got you into healthcare?

: You know I always had an interest in healthcare. 20 some years ago when I was trying to decide what I wanted to do with my life you know give very strong consideration to going to med school. A lot of my friends from that time are now practicing doctors and decided that actually the route I wanted to go was combined my interest in health care and technology as a way to potentially help many more patients that I could do as a practicing physician. So now fortunately I get to work with a lot of people in doctor and nursing and other clinical roles. But the route that I took was a way that I think we can leverage as I was saying a moment ago a lot of technology, cutting edge technology to solve some of the challenges that we see today in healthcare.

: That's so awesome and I'm so glad that it worked out for you. Obviously you've intertwined these two loves and now you're here you're doing some amazing things with the different organizations that you're involved with Cory with the company that you're focused on right now. What would you say today is a hot topic that needs to be on every medical leaders agenda?

: Well if we look at what's specifically hot right now you know we see artificial intelligence and machine learning. If we look at kind of technology and impact on healthcare those are definitely the buzzwords. But I think what needs to be on everyone's mind is not necessarily those specifics although it is worthwhile knowing some about those but how the world is rapidly changing technology is really impacting medicine today. And depending on your particular area of healthcare and that's going to vary a little bit. But broadly speaking we definitely see technology moving into actual healthcare at a much faster pace. And so developing and understanding at an organization around you that can support that I think is critical. You know what we see our healthcare system and healthcare institutions and companies that aren't adopting changes in technology are going to fall behind very quickly.

: Yeah and they're definitely a very big risk. Listeners, this is something that is worth reiterating. You know if you're not embracing some sort of organizational structure to help you embrace these digital advances these computer advances then you're gonna be left behind. And so Cory maybe we can ask you what would you recommend them. You know the listeners trying to stay up with the times. What would you recommend them as a basic step they could take.

: Well I think there are a lot of things that can be done. I mean just keeping up with technology trends and if you are not someone who's deeply embedded in the technology yourself at least have an understanding of what these things are and what these things mean artificial intelligence machine learning like I was talking about bitcoin and block chain. I think there's going to be an impact of block chain on healthcare. What does that mean to your business. You don't have to be the expert but have a high level understanding with them bringing those people around you or structure your organization so that you can at least start to answer some of those questions about what should we be doing today. What do we need to be looking at the next 6 to 12 months. What's a few years out and was completely irrelevant to us. You should have enough knowledge to be able to answer those questions and at least know where the impact in your business is going to be. And I think most importantly where the impact on providing care and providing patient outcomes is going to be.

: Beautiful. So listeners if you take anything from this episode there's plenty more to come but take just that. That framework that Cory laid out for you. Hit rewind on this. Listen to it again. Write it down. Because it's happening and it's happening fast. And so you don't want to get left behind. And so Cory you're obviously on the front end of this advances. Can you share with the listeners what you're doing potentially at the organization you're at now to improve outcomes.

: Absolutely. You know I think that we're on one of the many many front edges and that's what challenges right now is how many different things are happening. So Catalia Health is a chronic disease care management company. Now there are a lot of other people trying to deliver care management particularly when we think about the domain that we're in which is outside of the hospital or the clinic now helping patients do that everyday follow up. Now one way this is done today is you know we've got great home care agencies out there that are sending people out into the homes at a much bigger scale. This is happening using call centers full of nurses and other clinicians at times to make calls to patients. But both of those are really challenging to scale you know home health actually sending someone out that's extremely tight. It's a very expensive in many of these call center based programs. The other quote unquote high touch programs means you're going to talk to a patient a couple times a month. And that's great for the level of care that we're providing today. But we want to be able to do so much more. And that's where Catalia health comes in. So instead of these completely human driven interactions, we of course bring a bit of technology to play. We give our patients a cute little robot. It sits in their home on their kitchen counter bedside table coffee table wherever they want. And by the way if you to get a sense of what this looks like you can go to our website cataliahealth.com. And there's a short 90-second video there you can actually see someone interacting with one of these. And so that's the interface. And I think we can come back in a second. Talk about why we use that interface. But on the technology side most of what we do is the artificial intelligence behind that that's creating a conversation on the fly for that patient at that point in time. Now we build these around particular disease states for example we have these out with heart failure patients today. And these are checking in with a patient about what's going on related to their condition in the background we're modeling that patient that we can talk more about how this happens as well to tailor that conversation specifically to them. So this is partly about checking in. How are things going? Did you take your medications? What was your weight this morning? Partly about education. Helping the patient better understand their condition and the management of it and partly about motivating that patient to stay engaged. So one of our big challenges today in chronic care management is how do we keep patients on whatever that therapy whatever that program might be for an extended period of time. And that's a big area of focus for us. Now of course through this we're getting a lot of data. We have a lot better understanding about what's going on with that patient day to day than is practical to get now. So on the back end we're gathering that data doing the analysis and then sharing it with the doctor or the care manager and nurse for the pharmacy as needed depending on what patient population and we're working with. So at core we're focused on chronic care management but we have a very unique and scalable way of going about it.

: Cory, super cool and listeners take that link from Cory and you'll be able to see what the little robot looks like but more importantly you'll be able to see what the company is all about and it's that chronic care management in a way that provides data you know patient reported data. It's tough to get. And now with the advent of voice. With the advent of artificial intelligence like Cory said there's so many fronts to so many things that I think they're doing some really interesting work to help manage the patient when they leave the hospital which is a very challenging thing. Now Cory question for you, a lot of things come up you know people say it's a robot. We need humans. Is there a human touch to the robot. How's that whole thing work?

: All right there's a bunch of pieces to that you know. So let's start with what are we doing here. Where do we fit into the healthcare system. Our goal is not to replace any humans in doing their job. We're trying to help them do a better job. So we're not getting rid of those hom care programs. We're not replacing those call centers but as we were talking about those interactions tend to be infrequent. If I'm a patient dealing with a chronic disease, I'm dealing with that every day. This helps to fill in those gaps and then let the clinicians who are providing care understand the when and where they need to reach out to patients. So with that data we're able to better target the people time that we have in order to solve some of those problems. Now let's talk for a second about two quick things so one is why do we use a robot the first place? It would be a lot easier. Right. So it would be a lot easier to deliver these conversations through a smartphone or a tablet or through a web browser, on your laptop. But yes the analogy here and where this comes from is you know we're listening to a podcast right now but it would be different if we were having a face to face conversation. Now it would be logistically challenging for each of us to do that. But in business that's exactly what we do. As CEO of Catalia Health, I spend the majority of my time on the road with our customers, our partners, our investors, our patients and we all do that in business and in medicine because we understand that face to face makes a difference. And from a psychological perspective we actually know what that difference is. We're face to face with someone as opposed to a phone call or an email or even a video conference face to face means we're more engaged. We're creating a stronger relationship. We even find that person that we're talking with to be more credible more informative more trustworthy. Now as it turns out, those differences carry over into the world of technology. In other words, I put that robot in front of a patient that can literally look them in the eyes while it's starting to them. We get those psychological effects of face to face engagement. Now one or two interactions that you know may or may not be important but where that really makes a difference is over time. And if we compare head to head using an interface like we do with the robot versus delivering the same thing through an app, we're going to get much better engagement over time with our patients. And so that's what it really comes down to for us. And then the last thing I'll say on response to your question is how we go about creating this is not like a chatbot. So this is not technology that's listening for the patient to say something and then you know going out and searching a database doing some statistical analysis and trying to come up with some answer. The robots are really directing the conversation and all those conversations start with people start with experts in that disease state. At our company, obviously we are building a bit of technology but less than half of the company have are people with technology backgrounds. The other half of our product team are people who are clinicians, doctors, nurses, psychologists, writers our head writers are former Hollywood screenwriter and it's the interplay among all these things that make this work. In other words everything that maybe a robot is saying to a patient is clinically valid. It's been created by one of our researchers using you know best practices or literature that's available on managing a particular disease state. We have consulting clinicians who are experts in that disease state as well to help us understand that process and create that content but then also working with our writers to make sure that it comes across in a very friendly approachable way that's appropriate for that particular patient. Now the adaptation to that particular patient happens automatically. That's what helps the scale. Once we develop an application for a disease state it doesn't matter for rolling that out to 100 patients or 100000 patients. That part becomes easy once we have the first piece of this created around that particular disease state.

: Very cool Cory and no doubt that it's been very thoughtfully done. You guys are taking a very scientific but also human touch approach in the way that you guys are deploying the technology to help these patients. And also the people that are taking care of these patients. Can you give an example to the listeners of how your company has already improved outcomes with what you've done?

: So this company is about three and a half years old and as you might imagine from looking at the product there's a lot of infrastructure to build to get ready. So you know we've been fortunate that early this year we have finally launched with patients so we're still fairly early in the data.

: Congratulations.

: Thank you. However the first version of this was put in front of patients 11 or 12 years ago. So there's a lot of research behind this showing the ability to use this to keep patients on therapy for longer. Now our first roll-out this year of the Mabu commercial product is with heart failure patients and what we're seeing from the initial data is that patients are using this very frequently. So on a very regular basis once or twice a day and for a reasonably long period of time. So what that really means though is we're able to get the important information from patients. So in the case of heart failure we're asking about daily weight we're asking about shortness of breath and other symptoms. Now the critical things that we would want to know about a patient is as a clinician we were able to talk to them everyday and were also able to spend time educating that patient. Now, if we think about the example of heart failure but this applies in so many other places. You know, a patient gets a new diagnoses and all of a sudden there's a new drug there are three or five drugs in the case of many of these patients. And look you need to do this and you need to follow this diet. And you know here's your first follow up appointment here's your second I want you to think about this everyday and do this. It's overwhelming. It made this patient in the moment may feel like they understand it but they leave the hospital, they leave the doctors office and wait what was that. They don't recall what my doctors said about this. And the other thing that we see with our patients is that many of them are hesitant to reach out to call the doctor. I don't want to bother someone but knowing these things are incredibly important to managing care over time to improving outcomes on this disease to not going back to the hospital. And so what we're able to do and what we're seeing is that patients are willing to talk to Mabu the robot about these kinds of things day after day and so it's a way to deliver this educational content in a time and place when the patient is ready to receive it. So those are the things that we're really focused on in terms of being able to improve outcomes over time.

: That's wonderful Corey and one of the biggest problems is medication adherence right? Whatever we could do to improve medication adherence will be amazing.

: That is definitely one of the critical parts of it. You know we try to take a very broad view about managing an overall disease state. But you're absolutely right. Many of these diseases, the medication that that patient is on and today often the lack of proper adherence to it is one of the big challenges that we see.

: Yeah absolutely. Big problems you guys are doing some really great stuff to get them solved. Congratulations on launching this year with the first patients. And so now you guys are rocking and rolling as you've moved forward in this process. Cory, can you tell the listeners about a time when you had a setback on the way to this process. This launch finally and what you learned from that setback?

: Well you know it's kind of one of those things that you often see in business and particularly in technology where people see this now and you know think of it as brand new and I've been building stuff like this for two decades now. I launched my first company just over 10 years ago and obviously that was very early in terms of this kind of technology. And one of the challenges then is just figuring out what's the channel, how do we get this to market. We ended up doing deals with Pharma, with payers, providers, self-insured employers, direct to consumer and trying to figure that out. But there were a lot of setbacks along the way. You know one of the challenges when you're trying to do something new and different in healthcare is just figuring out where you fit in. And actually this is really shared across a lot of business but healthcare you know we definitely see this because for good reasons healthcare can be very slow moving. We figured out what works with patients. We don't want to change that. We don't want to introduce any risk in what we're doing. But that also has its challenges when we find something new that works in figuring out how to get it out there. And so I think one of the setbacks that I've seen often on over 10 years of working to sell this kind of technology is just figuring out who's going to pay for it and why. Part of what we're doing here is obviously developing a very new interface for patients. And what we're doing is unique. We're very differentiated in terms of that. But one thing I've had to figure out over the last decade is on the other side of this, the business side and where we fit into healthcare. How do we basically do the opposite and do nothing new? Because we have to fit into existing business models, existing payment models, existing workflow and understanding how to fit something new that we're doing into all of that has been a huge lesson learned over my career.

: That's such a great share Cory. Listeners if you're working on a new idea and even large companies. If you're implementing a new technology or a new product, who is going to pay for it and why. Truly understanding this is going to save you from a lot of headaches, heart aches, and over a hundred. Isn't there a Cory?

: Absolutely correct!

: Yeah, so make sure you think about this. You know so many people don't think about it. Make sure that you implement this thought into your strategy your go to market strategy. What would you say one of your proudest leadership moments in healthcare have been to date Cory?

Well I'm excited right now that I get to do a lot of public speaking about not only what we do with Catalia health but the impact of technology in healthcare particularly around artificial intelligence and sometimes around robotics and it's very exciting to see right now the response of this is receiving. People are genuinely excited about it and really trying to understand how they can use this to make a difference. Obviously I'm not the only one out there talking about this but it's something that I've focused on for a long time. So it's very exciting for me to see how this kind of thing is starting to have a real impact at health care.

: Tell us a little bit about an exciting project or focus that you're working on today. It could be something within Catalia or anything else that's on your mind?

: Well right now I'm very focused on what we're doing with patients with heart failure. So we launched with one of our customers about a month and a half ago it's Kaiser Permanente. So they're a great partner for us in rolling this out but we've also launched an internal pilot. So we are shipping these directly to patients and we're now getting feedback from those patients in terms of the data that we see every day. You know a data feed about what's going on across those patients but some of our nurses are on the phone with those patients and going to their homes and interviewing them and getting direct feedback. So this is something that's very exciting on the minds of not only me but everyone here at Catalia Health right now really focused on how do we make an impact on these patients and how do we use their feedback to continue to make what we're doing even better.

: Wow, that's so awesome. Definitely exciting Cory and you know I'm sure you and your team are are working around the clock to figure out how to best tweak these devices to best get patients what they need.

: It's a very important part of what we do. Starting with you know the foundational principles of medicine and psychology and building based on that but then using that real world feedback to continue to improve.

: Super amazing. I think you guys are doing some really great things Cory as we get to the end of this podcast, I've got a lightning round for you for questions. You and I are going to build a medical leadership course right here.

: What it takes to ..

: Alright.

: It's the 101 of Cory Kidd. So four questions on this syllabus. And then we're going to follow that with a favorite book and podcast. You're ready?

: Alright

: All right. What's the best way to improve health care outcomes?

: I think what I'm seeing right now is evaluate all angles to look for opportunities. So what I mean by that is you know health care problems are complicated. Sometimes the answer is in technology like we've been talking about, sometimes it's in process. Sometimes it's in people sometimes it's how do you do something earlier or how do you postpone something to later. And just thinking about it from many different ways which usually means a pretty diverse group of people who have some knowledge of that problem I think is the best way to go about it.

: Awesome. What's the biggest mistake or pitfall to avoid?

: One thing I've seen in my career being involved with the technology side of healthcare is kind of the desire for the shiny new thing. I thought about this a little bit tangentially earlier in understanding where AI or a block chain or machine learning or whatever it might be is an impact on your business. And one of those options that I stated was it has no impact, right? It doesn't matter. Understanding that answer I think is incredibly important and I think that's the answer that's often overlooked. There are these hot technologies that catch on in certain areas. Well it must have an impact on our business. Let's do something. And I've seen a lot of health care organizations spend a lot of time and money and figuring out that that just doesn't matter to them.

: What a great call out. How do you stay relevant despite all the change?

: You know I think that's always a challenge particularly as an organization grows. I think part of it is you know just following the trends that are going on and you know understanding what they are at least enough to be able to explain what it is. I think also you know as organizations grow keeping people around you who do the same. Trying to find people who aren't just about the status quo in whatever that is, whatever aspect of your business or the health care that you're providing, but people who are excited about trying and doing different things.

: And finally what's an area of focus that should drive everything in a health organization?

: Patient outcomes. What are we actually doing with our patients. I think that's critical.

: Love it. And what book would you recommend to the listeners?

: All right, I'm going to take something from a technology perspective this is an older book several decades old called Society of Mind. So this is a book that was written by Marvin Minsky 3 or 4 decades ago now. So everyone is familiar with the term artificial intelligence. Not many people know where it came from. Marvin was one of the early people working in this space and he and Joe McCarthy coined the term artificial intelligence a little over 60 years ago now. And so the whole premise of this book one of the ones in the middle of his career is that a mind or thinking or this higher level thought processes all come from simpler things that are happening under the hood if you will right smaller simpler things that we can search to figure out and decompose. And if I look at the work that I've done for the last 20 years this is one of the principles that it's really based on. You know we build these really complex systems with Mabu and the data analysis that we're doing on the back end. But any one piece of it is fairly simple. I was fortunate to be able to study under Marven grad school and get some of these ideas from him firsthand but well before that at least a decade before that I'd read this book and I highly recommend that if you want to understand the basics of artificial intelligence. This is a very approachable accessible book.

: What a great recommendation and what podcasts would you recommend to the listeners?

: What I'm enjoying right now is Masters of scale by Reid Hoffman, he was one of the founders of linkedIn. He is a venture partner now. But he has done it. You know he has access to a lot of amazing entrepreneurs whether they be small companies or many of them are a very very big companies now. But what does it take to do something at scale? He approaches that from many different angles and I'm greatly enjoying it and trying to figure out how he can apply many of these lessons in my business today.

: What a great recommendation. Listeners don't worry about writing this down. Just go to outcomesrocket.health/catalia and you're going to be able to find the show notes as well as a transcript just so you know catalia is C.A.T.A.L.I.A. Just go to outcomesrocket.health/catalia. You'll be able to find the links to the book that Cory recommended, the podcast and everything that we talked about today. Cory, this has been a ton of fun. I'd love if you could just share a closing thought with the listeners and then the best place where they can get a hold of you.

: Closing thought would be make a change. Try to do something different. Try to figure out where you can have an impact. That's what really drives everything that I do in my career. And I love working with people who think the same way regardless of what that change is. And a couple of great places to reach me. I'm on Twitter @Coryk. I'm pretty easy to find on LinkedIn as well. If you want to reach out just add a message to it.

: Outstanding. Cory, thank you so much. We really appreciate all the things that you share with us today and we're excited to keep up with all the outstanding things that you're up to. So thanks again for making time for us.

: Well thank you so much for the invitation. This was a great conversation and I look forward to hearing from the listeners.

Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is "implementation is innovation". Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book and Podcast:

The Society of Mind

Masters of Scale podcast

Best Way to Contact Cory:

Linkedin - Cory Kidd

Twitter - @coryk

Mentioned Link/s:

http://www.cataliahealth.com/

Episode Sponsor:

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Outcomes Rocket - Blake Marggraff

Leveraging Data and Practitioner Insights to Improve Outcomes with Blake Marggraff, CEO at Epharmix

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I really thank you for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have an outstanding individual in health care. His name is Blake Marggraff. He's the CEO at Epharmix. Over at Epharmix, they're focused on keeping the toughest and most expensive 20% of patients in touch with their outpatient care teams at risk bearing health organizations. They're really focused by using their digital health platform to make this hard to take care of group even easier to take care of and to take costs out of the equation all at the same time while improving outcomes. He worked so hard to do this. We had his co-founder and chief medical officer Avec Sam on the podcast and I'm thrilled to be able to have Blake carve out some time with us on the outcomes rocket. Blake, welcome to the podcast my friend and maybe fill in any of the gaps that I missed in your intro.

: Thank you, no, say it's a it's it's a pleasure to join today. My background is still relatively brief and I'm 25 years old and my passion in healthcare started kind of paradoxically when I moved from through medicine research into the technology side of things back in 2011. I ended up participating in a winning something called Intel Science Engineering Fair and that frankly it gave me the chance to meet folks like folks like you and having conversations. I mean you're surrounded by these mind that Medtronic right. But it is pretty rare to have conversations about things that are impactful but impactful and really scalable way. And I fell in love with the idea of spending every moment that I could. Working not just on making the world a better place for some people but for as many people as possible and jumping to the point really the two ways to do that or help people live better lives or to help people live longer lives and health is two birds with one stone in that regard.

: That's awesome Blake. You know you guys are so passionate about what you do there at Epharmix and there's no doubt your leadership and what you bring to the table is a big part of that. What today in your mind is a hot topic that needs to be an every medical leaders agenda. And how are you and your team at Epharmix tackling that?

: Oh great question. So I'm first going to stand on my soapbox for just five seconds. I think that a lot of folks cite AI as the hot topic of the day and really artificial intelligence machine learning those are means to an end and multiple ends, right? I think that the real hot topic the crux of it is data and specifically the rare data that enables those AI engines if you will to run the most powerful way possible. So my focus and I think for a lot of health care leaders should be focused is on asking the right questions and then collecting the pertinent data to help inform the answers to those questions. That's why our team is focused on not just all the data we can get but the right pieces of data.

: Getting the right data. And it's not easy right? And so maybe you could talk to us about what you guys are doing at Epharmix to get clean data and how you're doing it and maybe some of the results that have come out of that.

: Absolutely. So Epharmix keeps the toughest patients engaged for a really long time. As you said and it turns out that it's pretty easy to get most patients to answer a few questions once or twice. It gets much more difficult when you look at engaging chronically ill especially poly chronic populations that are not tech and able and you keeping those patients engaged for months or years on it. And that's where we specialize. So by the numbers Epharmix has more than 63% engagement for a full 52 week window. We're over 50% engagement for 100 weeks. So pushing that 2 year mark which is pretty striking given that in some of our populations the average income is $12,000 a year and I think very humbly made made all the more impressive by the fact that independent clinical researchers now shown that Epharmix tools drive real outcomes when combined with care management. It's not just Epharmix but Epharmix is a necessary piece of that puzzle. And an example there we reduce the hospitalization likelihood for COPD patients versus control by more than 60% drop A1C for patients with diabetes by more than one absolute percent. So starting with an A1C of over eight even help get hypertension patients under control and moving about half of the hypertensive patients back into the prehypertensive state. And we do that to your point and to your question by not just asking all the questions that we could ask but instead by almost sniper picking the right questions and collecting those rare data that are then related to the care teams. The care team can reach out use their clinical expertise and inform care.

: That's pretty cool Blake. And so you guys have a very thoughtful approach. You're getting results. The evidence is is in the numbers. You've also been featured in a lot of different publications like entrepreneur Moby health news, Bekkers and so you're definitely creating some traction out there and you're getting some attention through the process. What would you say has been one of the key learnings right I think as the listeners that tune in that our digital health entrepreneurs they are going through the trenches and the peaks and so maybe you could share with us a time when you had a setback or a failure what you learned from that and what you do now as as a result of it?

: Just picking one time as the challenge to spend at least 15 minutes those since my last one so I'd say a theme of failures. Not only that we've experienced to be Epharmix but I think that a lot of folks coming in to try to be really good industry partners struggle with is health care is not a turnkey industry. Most enterprise sales have some level of complexity but I would say that healthcare has to rival the most complex ones. So going in and saying we have this fantastic software as a service offering we're going to throw it over to you. You're going to buy, you're going to pay us money then we're going to stay hands off and watch it as it delivers tons of value. That's unrealistic to say. So big failure is acting that way. And then of course the converse of that is by being really hands-on, by treating every health system has its own unique entity with its own flaws and opportunities. We can help them succeed. Maybe a more specific failure. I think something that's fascinating on the research and development side is Epharmix also supports populations such as Mothers on Medicaid or feeding postpartum depression and a number of other related indications or stages. And our first attempt at EPX breastfeeding which was intended to increase the number of months for which a new mother would breastfeed her first child. That first attempt flopped. So it was a blaze of failure. It was incredible. Folks stop using it within days the feedback was that it was almost offensive and we were applying all of our best design practices to this. Right we gone through the same. So we pulled back really embraced the patient centric design mentality. We even brought in ... to begin providing feedback on the product. And finally landed on something that wasn't good academically or at least wasn't driven by the academic best practices but was instead driven by real feedback from those new mothers and the folks who helped support them right after you know immediate postpartum. And it was night and day. The engagement the theme.

: Nice!

: That suddenly became a tremendously positive,so.

: That's such a great share Blake and friends. You listen to Blake's passion you know even when he's talking about his setbacks he's engaged he's all in and you know this topic of high tech versus high touch. There's no versus. You got a little bit of both. If you're going to really succeed in this field and for those thinking that they could just throw on software and walk away like Blake said you're making a big mistake. So Blake I'm glad you highlighted this very common misconception that people make when they come from tech into health. And it seems like it's something that you guys learn very quickly and you're implementing very quickly as well to scale.

: I appreciate that. Hopefully we keep learning more and more.

: Hey Blake, so tell us about what are your proudest leadership moments to date with Epharmix?

: We've helped a lot of patients. Well into the high thousands of patients now across the range of disease states and I think one of the most impactful moments was early on as a team. But you won't have a company and now we're more than two and a half years old and we had just closed one of our first commercial customers and one of the care managers shot an email to one of our managers saying hey I have some feedback for you. Essentially explains that Epharrmix had helped a patient who later admitted that he had given up on his self and helped the patient to begin tracking blood sugars. You know really simple just basic diabetes management and had really fundamentally changed the trajectory of that patients health by empowering the patient which was our focus really is sustainable outcomes long term outcomes. But seeing that shift in someone who frankly had been failed by the healthcare system not through any malice but simply as a result of the of the conditions and incentives that surrounded that patient. That was pretty powerful. That got smiles on our faces for a few days afterward.

: That's awesome. Yeah and you know specially when you're impacting the lives of people and you're seeing them come through your system and you know that you're actually making the lives of folks better. There's nothing more awesome than to be able to do that. So within Epharmix, you guys are working on a lot right? You already have a lot of specialties that you focus on. But what would you say today is one of the most exciting projects or focuses that you're working on?

: Sure. So a couple of categories. One is really making the most of the rare data that we have and that generally means we have an excellent tool for patient engagement and we're able to drive outcomes as a result of that long term engagement. But the next two stages are predicting adverse outcomes and then helping prevent those outcomes. So a lot of team energy in the background goes to baking those capabilities into product. For instance we have a couple of publications in the pipeline that show really compelling outcomes you know meaningful, high area under curve predictions with relatively straightforward machine learning models and we find the right model out of dumpsters that we try that can even predict for instance suicidality within a set timeframe for a pediatric Medicaid population or adolescent population really really powerful predictive models. That's one category. I mean it's amazing what you can do if you have the right data at the right time. The other area that's got me very excited is helping to make scalable some of those. As you would say high touch elements of service delivery. Right. So we have these fundamentally very strong, very robust product that helps care teams keep patients engaged. But what can we do to go upstream and make sure that patient enrollment and initial engagement is painless almost enjoyable for the provider and then go further downstream and deliver insights almost management oriented analytics to the economic buyer to the V.P. or the management level individual to not only showed that Epharmix is delivering value but also help them make strategic decisions based on those trends. So that upstream downstream I'd say it's another form of vertical integration of our product and our service offering that's got me pretty excited.

: That is pretty exciting Blake. And as you look at you know you guys are focused so clearly on getting the right forms of data. What would you say a good thing that health leaders need to focus on to get that data and maybe not just health leaders but also other tech companies right. How do you ask the right questions and how do you come up with those questions?

: Fantastic question. So that cuts to the research and development approach that Epharmix uses to try increasingly convinced it's a very strong way to build a product especially for a complex industry like healthcare which is a combination of standing on the shoulders of giants do a literature review understand what's already out there and then be comfortable iterating and failing and iterating and failing through until you have product is demonstrating itself and its value. In other words start with the best possible position you can, learn from the experts and then go through the process yourself embrace the experimental method and I would say to folks who are looking at all of the data that come from their AHRs all the way to hopefully potential partners such as Epharmix in the industry that are smaller innovators lean into the real reality that you will fail 85-90% of the time and that only by going through that process until you have a solid product can you deliver real value to your own workers.

: That's pretty cool Blake and what I love about what you guys are doing while you're a young organization. You guys are so focused on delivering value and putting together those randomized controlled trials and implementing the solutions to your different partners that you already partnered with. And it's so cool to have met you guys two years ago and now seeing where you're at today is just so awesome you know so.

: I appreciate that. You've been there for pretty much the entire Epharmix story come to think of it.

: And it's pretty cool you know. And I love seeing young companies succeed and there's no doubt in my mind that if you guys keep doing the same thing you're going to keep having the success that you've had early on.

: I appreciate that.

: So let's dive into the 101 course of Blake Marggraff. This is where we are is where we talk through what it takes to be successful and healthcare through business and technology. And so we're going to write out a syllabus using some lightning round questions I've got for them for you. And then we're going to follow that with a book and a podcast that you recommend to the listeners. You ready?

: Definitely.

: Awesome Blake. So what's the best way to improve health care outcome?

: I think the single best way is to intelligently distribute risk and I say that because right now when you look at the perverse incentives that arise there are usually there because either over a certain period of time or just an order of magnitude risk is not distributed among all stakeholders.

: What's the biggest mistake or pitfall to avoid?

: Don't assume people want to change let alone that people will change if given the opportunity and when you're making clinical improvements. Keep that in mind.

: I love that Blake spoken from experience right.

: Unfortunately, yes.

: And listeners if you're hearing this is all too common with new products and health care do not assume people want to change and Blake I'm glad you brought that out. How do you stay relevant as an organization despite constant change?

: So this one kind of has a logical corollary that's pretty obvious I guess which is make yourself irrelevant as long as you're the one making your previous so obsolete then almost the fact that you'll continue to grow and prove it.

: Love it. Why and what is one area of focus that should drive everything in healthcare?

: So I have to say we're all speaking the same language here from outcomes rocket. It's sustained outcomes. It's driving meaningful clinical value and thus financial value and not only driving it for weeks or months but for years on it.

: And finally what book and what podcast would you recommend to listeners on the syllabus Blake?

: So Peter T.L. released a book that was co-written by Blake Masters called Zero to One which stands out and says one of my favorites. And I'd say in terms of podcasts I'm going to go away from the healthcare side just a little bit and recommend to all who had not discovered it yet Radiolab which I can describe as morphiscience fantastic treasure trove of mental models and an impactful memorable stories.

: Amazing sounds very intriguing one that I'll add to my list and it's called Radiolab?

: Radiolab.

Awesome. Fantastic. Listeners, there have it. You have the one on one of Blake Marggraff and also some of the best resources in the industry here that he just shares some great resources and also we'll have the transcript there for you. Just go to outcomesrocket.health/blakem. Blake M. and you'll be able to find all that there. Blake, great times here with you today. Before we conclude I love if you could just share a closing thought and then the best place for the listeners could get a hold of you.

: For everyone out there who's part of a team leading a team anything consider asking yourself and your team the simple question. If we weren't already doing X would we start doing it today? And I think a lot of a lot of the fundamental flaws in health care would at least be solved a little bit. If folks would ask that question and getting in touch is pretty easy. We've made my email very tricky it's blake@epharmix.com. Drop me a line and I'd love to set-up time or follow the company or me at Epharmix or at @blakemarggraff.

: Oustanding Blake. Listen this has been a blast. Really appreciate the time that you spent with us today. Folks if you haven't checked them out Epharmix they're doing some pretty amazing things so definitely check out the show notes, click on that link. Find out what these folks are up to because they're really taken health care to the next level and Blake again, just wanna say thank you on behalf of all of us my friend.

: Thank you all. Really a pleasure. Appreciate it.

: Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is "implementation is innovation". Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book and Podcast:

Zero to One: Notes on Startups, or How to Build the Future

Radiolab

Best Ways to Contact Blake:

blake@epharmix.com

@BlakeMarggraff

Mentioned Link/s:

https://www.epharmix.com/

Episode Sponsor:

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Outcomes Rocket - Matt Schwartz

Why Improving Colorectal Cancer Outcomes is the Focus of this Entrepreneur and How He's Doing it with Matt Schwartz, CEO & Co-Founder, Virgo

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing health care thinkathon. That's outcomesrocket.health/conference.

: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I thank you for tuning in and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's guest because he is an amazing collaborator in health care and a good friend. His name is Matt Schwartz. He's the CEO and co-founder at Virgo. They're doing some pretty cool things over there. They're a med tech company startup that is developing a hands free cloud based video recording system for colonoscopy. Now Matt has an amazing history in product management in healthcare that includes time at Intuitive Surgical as well as NuVasive which is where he and I first met. And so now he's doing his own thing and I just want to give Matt a warm welcome and Matt please fill in the gaps of that intro.

: Now that sounds great. Thanks so much, Saul it's really a pleasure to chat with you had been a couple of years I think since we're together NuVasive in it. It's good to be on the phone with you now. We appreciate you having me on.

: Absolutely brother. So tell me Matt. We've had a chance to connect. But why did you decide to get into health care to begin with?

: Yes sure thing. So my dad is actually a doctor. So for as long as I can remember Medicine has just been a part of my life. I remember when I was a little kid he'd be preparing for a big surgery and we'd be in the living room he'd be watching surgical footage on the big screen. So it's like it's just part of my life ever since growing up I was always pretty interested in technology and just solving big problems. So the summer after my freshman year I got an internship out with NuVasive in the marketing department. And I think you know maybe my first meeting sitting in on a product building meeting and I just I fell in love instantly with medical technology and saw it as a great opportunity to solve really big problems that would have a big impact on the world and help improve people's lives. So I really excited by that. I went back to school and changed my major biomedical engineering and the rest is really history.

: That's awesome man. That's awesome. And you know wow while we were there listeners, Matt was always come out with out of the box ideas to help modify certain surgical instruments or implants and it's really no surprise to me that he ended up starting his own firm. And so right now, Matt what would you say a hot topic that needs to be on every medical leaders agenda and how are you guys addressing that?

: Yeah sure thing. So I know from our perspective there are a lot of I don't know if you called buzz words or hot topics in healthcare that people always harp on. Me and when my cofounders were just out at HIMMS a few weeks ago and interoperability and I were to really really hot topics that everyone's talking about. I think from our perspective we like to I don't really feel a little bit contrarian or thinking about things from first principles so we are big fans of interoperability and AI but we try to approach it from a different angle and the thing we really like to think about is better data capture and maybe alternative styles of data capture. So it's no secret that there's a ton of data in the healthcare world you know a lot of it is residing in the medical records system impact systems radiological images. But we actually believe that if you if you think back to how EHR got started, how pact system got started. There's a lot of great information about what is happening in healthcare but not necessarily. Why that stuff is happening. EHRs are kind of a thing you can say design to be building of system of records for billing. Not so much for the actual clinical experience not truly documenting what the doctors do. And so you know now it comes time where people are seeing all these great advances in AI and what can be done with massive amounts of data. So they're trying to apply that healthcare and we don't really think it's any surprise that there haven't been massive strides made in applying AI in a clinical setting and we think there's a real reason for that is just because it comes back the data the actual data is being captured isn't truly representative of the sort of information that doctors are using to make clinical decisions. And that's a big part of what we're thinking about it Virgo is how we capture different data sources that are currently going on that maybe reside outside the medical record. And how do we do that in a way that will over the longer term lead to really productive clinical applications of AI.

: That's pretty interesting and tell us a little bit more about why colonoscopy versus any other thing that you could do?

: Yeah. So when I first had this idea for doing better video capture in healthcare in my time in NuVasive while I was with Intuitive Surgical I'd go out to surgeries around the country and you may remember from our times Nuvasive, I would often try and try to capture the video and it into like a marketing piece or sales tool

: Yes

: And found that whenever we can do it it was really impactful but it was super hard to actually capture that video footage. So when I ended up leaving intuitive, my first thought was of great I'll call it all the doctors they used to work with, orthopedists, neurosurgeon, laparoscopic surgeons, robotic surgeons. And it turned out that getting them excited about video capture or as excited as I was at the time was like pulling teeth. Some of them like it but it was the resounding enthusiasm that I was really hoping for and sort of a little bit on a hunch. I called up one of my elementary school friends dad who is a gastroenterologist and that was the first time ever a doctor really really excited about doing this video capture and in hindsight it makes a lot of sense you gastroenterology is largely a video driven specialty when doctors are doing colonoscopies or upper endoscopy they're looking at the video screen during the entire procedure and they nerd out on things like 40 video sensors and the latest and greatest in TV monitors. So it's no surprise to us now that they were had this untapped need an untapped demand for video captures just hasn't been accessible to them today. And at the same time it is an incredibly high volume specialty. So it turned out to be a pretty natural fit for what we're working on.

: That's pretty cool. That's pretty cool man. So today can you give us an example of how your system or you know the things that you guys are doing at Virgo are improving outcomes?

: Yes. So you know we're still very much a startup. So we're we're trying to prove how our system can improve outcomes over time but it's definitely something that we're trying to build into the very nature of Virgo as a company and what we're Virgo's all about. And so one of the things we think a lot about is that documentation today for GI endoscopy we think it's just some are. So if you take a call an IP or an upper endoscopy it could be 20 minutes long to two hours long. And it is this video is a section of video. But at the end of the day what gets captured in the medical record is distilled down to a few blurry still images and text notes. And we just think that there's got to be a better way that that seems crazy to us. Fundamentally we believe that doing better documentation will lead to better outcomes. And there's actually some pretty interesting research out of the University of Oklahoma where they instituted a policy of systematic video capture for their endoscopy. And what they found is in doing so just by setting up this policy they told him we're going to start recording. They took some of the and off that were low performers before the video recording and just sort of miraculously by doing this video capture afterward it really improved the performance and increase the frequency with which they detected precancerous polyps or added nos. And that's really interesting to us the authors sort of hypothesize that it's just the observer effect or the Hawthorne effect where if you give a little bit of oversight you're going to in some way influence the performance hopefully for the better. And we think that that can be applied at a much broader scale and that's really just a starting point you know step one is to have a little bit of oversight and do a better job documenting what's going on. Step two is actually taking a close look at that documentation and trying to understand where there are areas for improvement. How can we use video or better research, better training, all sorts of different quality improvement initiatives and then really our long term goal in doing this is to create an unbelievable repository of Clonoscopy videos and other G.I. endoscopy videos that are incredibly high quality as well as well labeled and well-structured. And from that we think we can use various computer vision and AI principles to drive the new insights and create new technologies along the lines of automated pilot detection and classification, things that will really move the needle forward and healthier.

: That's pretty cool man and very exciting and it's fascinating how many companies are signed up fly machine learning or deep learning algorithms to technologies like yours to get insights.

: Yeah absolutely.

: Hey Matt tell me something. It's not always been rainbows and sunshine for you. Maybe you could take us to a moment where you had a mistake or failure and what you learned from that.

: Yes. So I've learned in the startup world that basically every day is just a series of mistake and trying to pick yourself up off the floor. That's really fine. Actually I think a good example is thinking back to when I was really knocking on doors of the physicians that I've worked with in the past. When I first quit my job at intuitive, I was working from the home office which was the desk next to my bed and it was pretty trying time. You know I was just calling everyone I could possibly get a hold of in my network and it was actually on a holiday. And so people are starting to go dork on me and I was getting pretty worried that if this wasn't really going to go anywhere it wasn't and it got to that was I think a bit of a failing and a mistake. I spent a lot of time just trying to go down the same pathway of talk to doctors and try to sell them on the idea as opposed to find an area where maybe the idea had more merit. And like I said it got pretty lucky. Just sort of coincidentally stumbling into gastroenterology and really finding a lot of room to run there and things really took off after that we went to a really popular G.I. conference and just got linked up with some of the movers and shakers in the world and things took off from there.

: That's pretty awesome man. And it's.

: Come a long way there.

: Yeah that's so great man. I'm glad things are working out for you guys and it's exciting and gut wrenching too when you're in a position you you know you took the leap and you just didn't know how is going to work out. But you stuck in there long enough and that's what you have to do to be able to see the light and the other side of the tunnel.

: Yeah no doubt they had a great support system around me. My now fiance was great.

: Congratulations.

: She's super supportive my parents as well and my friends and the guys that eventually became my co-founders do the really important part of making things up.

: That's awesome, Matt. Hey tell us about it within Virgo a project that you're working on that you're excited about.

: Yeah. So something we are super excited about is incorporating voice control and voice capturer into the video product itself. So we initially identified the major need in GI endoscopy where there's all this video and people that have a good way to capture it if they want to do it today and they need like these archaic DVD recording systems huge pain and along the way we have learned from the doctors we're working with that there's other challenges that they face and areas where some new technology and kind of the innovation can really improve their workflow. So today in order for doctors to use our system they basically have the also connected to an internet browser whether it's on a desktop or a mobile phone and it requires a little bit of clicking until the system does start and stop that they're doing a new procedure and something we're developing right now working on it. The ability for doctors to control the video recordings just with the sound of their voice so they can basically say let's Virgo get a new procedure going. They set up the new procedure with boys then they can say Virgo's start to start a clip, Virgo's stop, stop a clip. And I think the thing that we're all most excited about is that they can and they Burgo take my note when they say Virgo take my note they can actually dictate in real time what it is that they're seeing and doing in the procedure. And the reason that's so impactful is when doctors are now in the middle of a procedure they've got gloves on their hands are full they can't be bothered to you know turn around and operate a computer at the same time. And that's where boys become so powerful they can just say exactly what it is that they're seeing or doing. And in today's workflow when GIs finish up the call on the say they take the gloves off and the first thing they go do is sit down at the computer and review all those still images and type up the notes from memory and the fact that they're doing it from memory. Yeah I think it's important. They're doing it from memory because while doctors are amazing and people have great memories we all know memory is not perfect and it's pretty challenging to try to remember every little thing that happened during the course of the procedure where certain parts were located pretty taxing and time consuming. And so we think with voice control, there's a huge opportunity to automate that part of the doctor's workflow so that when they take their gloves off the procedure note is just ready to go for them to review and submit to the medical record. So we think that's going to be just incredible technology the doctors will work with are super excited about it.

: Well definitely game changing, Matt. I mean so many hours are spent in front of the computer and you know as physicians you don't want to do that. You want to take careof patients.

: Totally.

: So I think it's so cool that that this capability you guys are building in this capability and super exciting for physicians to be able to be more more efficient with their time.

: Yeah absolutely yeah. More efficient with their time than the other piece. It's not just the efficiency but we think actually the accuracy of the notes will improve. I remember when I was a little kid my dad would have to dictate cases and it was so time consuming that oftentimes he would like save up a week's worth of papers and then do it on the couch over the weekend. Yeah and I'm sure he did a great job. But it's hard to remember all the nuance details what goes on in the clinical encounter and we think it's just a better approach to try to capture that data and actually happening and really make sure that that is much beneficial data as captured as possible.

: Yeah. And you know to your point this is application that could go beyond the colonoscopy.

: You absolutely. Absolutely we're starting with one of the GI. We think there's other areas in healthcare that could really benefit from this essentially anywhere that there's video data being generated or potentially audio data being generated in healthcare that's not being captured today. The underlying technology is really applicable it's just a matter of figuring out the right way to bring the technology to market. So some of the other areas we're thinking about OBgyn it's really popular one where not just on the surgical side with laparoscopic hysterectomy and other procedures but also prenatal sonograms or ultrasound right now is another thing kind of stuck in the target is a little bit where as patients you go in for the ultrasound you leave with like a little polaroid prints out of the picture. I talked to a lot of friends that are kind of going through the pregnancy process now and I've asked them video something you'd be interested in and just about unanimously they say yes they would love to have a video of the ultrasound that they could. Yeah exactly a clip they can share on Facebook on YouTube whatever they might want to do that. And then also from the clinical side the fact that that video is not being captured right now we think is just a disservice to the overall public health.

: Man that is so cool and exciting so that for sharing that and listeners, this is pretty awesome stuff. You know if you are thinking about how you can do innovative things in your facility if your provider definitely at the end of the podcast will have match share his information so that you guys could reach out. Matt, let's pretend we're building a medical leadership course on what it takes to be successful in medicine today. The 101 of Matt Schwartz. So we're going to write out a syllabus and I've got four questions for you lining around style followed by a book and a podcast that you recommend to the listeners. You ready?

: Very cool.

: All right. What's the best way to improve health care outcomes?

: So I think I'd be lying if I said I knew the answer to that. I'm still a fairly young guy. You know we've been in the industry for maybe 10 years but something that several of my mentors have preached to me and that has really resonated is the importance of clinical competency and what I mean by that is that real clinical understanding if you put in the time and work is accessible to really anyone it's not just physicians that can understand the clinical landscape but it does take a lot of work. And I think it's important to approach it really scientifically. So that means doing things like reading scientific journals and medical journals and not just cherry picking articles that you like or the pieces that you like but really understanding the strengths and weaknesses of different studies. It also means going to medical conferences and engaging with physicians and healthcare administrators and listening to them have engaging conversations and debate. The other big piece is to actually spend time in various health care setting. This is something you know when I was like just an intern at NuVasive they would throw me into cadaver labs with physicians and just just to be an observer and try to gather that information was really critical and then beyond that you know going into operating rooms observing surgery is always incredibly enlightening. Also you know just hanging around hospitals being in the waiting room going down to the serial processing department meeting as many folks in health care as possible and even shadowing doctors during clinic that's something I did a few times in my career. And every time I did it I just came away with these little pearls of wisdom that wouldn't have happened otherwise. And I think in order to contribute to improving health care it's important to have that well-rounded background of the healthcare space.

: For sure. What's the biggest mistake or pitfall to avoid?

: Yes so I think actually sort of tied in to the last question where if you're going to go around and solicit all this feedback and with that opinion you will hear a lot of different things and especially in the healthcare space to find that a lot of people have really strong opinions one way or the other. And with that it can be easy to fall into this trap of sort of like feedback whiplash where someone tells you something that sounds great and then the next day someone tells you something completely different and it can be easy to lose focus through that and keep chasing just the most recent bit of feedback. And what I think is important is to try to always take a step back and be the synthesizer of that information you can't always follow every one little anecdote but you can try to take them in aggregate and kind of parse out some overriding insights that are useful.

: A great takeaway. How do you stay relevant as an organization despite constant change?

: So I think this comes down to just constantly remaining curious. Curiosity is another thing that you know my mentors try to instill in me. And the best physicians that I've ever worked with industry have always been the ones that are the most curious because I think that it causes you to never settle or be complacent. And so it's something that we've tried to instill in as an organization you know. We're still pretty small there's seven of us now on the team and I think we're just inherently a pretty curious bunch but as we grow that curiosity is something I want to try to continue to foster. One of the things we're going to be actually working on this quarter is rolling out a Colan class which is sort of modeled off of the spine exam that we have at NuVasive where everyone in the company was required to learn you know spinal anatomy spinal procedures. What technologies out there on the market what the surgical procedures are like. And I thought that was just incredible it created this common language and enabled everyone in the company regardless of what you're doing to be curious about how things can be improved. And so we're excited to get that started with Virgo and who is going to foster a lot of curiosity down the road.

: That's awesome. Hey what's one area of focus that should drive everything in a healthcare company?

: It may sound obvious but I think the answer has the patient outcomes. If at the end of the day everything always comes back to the patient. There's a ton of stakeholders in healthcare. Obviously the mission the provider the payers got hospitals but at the end of the day everyone's really reporting to the patient. And if you keep that in mind and keep that is true north I think will go a long way. That's definitely the reason we started Virgo was to improve patient outcomes in our mission statement is to use video capture data capture and AI to ultimately improve outcomes when it comes to colorectal cancer and other G.I. disorders. So I think that that's going to be number one.

: Love it Matt, that's so awesome. And talk to us about a book and a podcast that you recommend to the listeners.

: All right. So my favorite book of all time is called The Elegant Universe by Brian Greene. And it's a book about cosmology and general relativity and quantum mechanics and string theory, theoretical physics in general and it sounds like a pretty heavy topic but it was written to be just absolutely engaging and accessible to anyone. So I think I read I read the book when I was maybe 13 or 14 like eighth grade or freshman year of high school. So I couldn't really follow along with much of the math but the examples are there just so well explained and accessible to the layperson and the part that I just love about the book is when you start to look at the world outside of our everyday scale, like things that are on our scale of speed and timing distance everything feels just intuitive at that level but when you step outside that scale things get really really counter-intuitive really quickly and that it blew my mind. And that thing is that I think it's a great lesson to take for really everything even in the business world. You know when you're solving small challenges or kind of normal scale challenges the answer might be intuitive. But when you try to step outside of that and do things that are really big in impact whole systems or whole population a lot of times the solution is going to be counter-intuitive. So it's all the more important to be really rigorous and scientific in the way you approach solving it.

: It's awesome. A good book and what podcast?

: Oh podcast so. Oh man there's so many podcasts I love. I think the first podcast ever listened to was the Bill Simmons CBS report ESPN podcast. When I was in college. But I say right now my favorite podcast is called The Waking Up podcast by Sam Harris. He's just the super intellectual guy I've been reading his books since I was young kid too. And just think he has a really really rational approach to just about everything he does need to be well thought out. Yes. Really interesting guests on the podcast covers a wide range of topics from religion and politics all the way to meditation and Buddhism. So I would highly recommend anyone check it out.

: That's awesome. Sounds like a really good one Matt. Appreciate those recommendations and listeners. Don't worry about jotting down. Just go to outcomesrocket.health/Virgo and you're going to be able to find the show notes as well as a transcript of our conversation, links to the book links to the podcast as well as Mat's company map. This has been a ton of fun. I'd love if you could just share a closing thought with the listeners and the best place where they can get ahold of you.

: Yeah absolutely. Well first of all just wanted to say thanks again for having me on. It's been an absolute blast. Really enjoyed the conversation I guess as a closing thought. Just ask the listeners out there to stay curious and stay hungry. There is obviously an incredible amount of progress to be made in the healthier world and you never know where great ideas are going to come from. Oftentimes they're just hiding in plain sight. So we encourage anyone that just interested in making a difference. Spend some time and reflect on care world and try to engage in deep thought and do what you can come up with. So it's hard as the easiest way for folks to get in touch with me would love to hear from any of the listeners. There were currently looking for like minded folks that are excited about what we're building at Virgo. So the easiest way to contact me my Twitter is @iAstrophoto. So a little bit of a strange handle on amateur astronomy enthusiast then a little bit of astrophotography though. Started my Twitter handle with a about taking photos of space through my telescope with an iPhone though @iAstrophoto on Twitter.

: I love it I love it. That's awesome Matt listeners. There you have it. I've got the best place to contact Matt. Also stay curious what a great message from him today and Matt just want to say thank you again for spending time with us. Looking forward to staying in touch.

Awesome. Thanks so much Saul.

Thanks for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book and Podcast:

The Elegant Universe

https://samharris.org/podcast/

Best Way to Contact Matt:

@iAstrophoto

Mentioned Link:

https://virgosvs.com/

Episode Sponsor:

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Outcomes Rocket - Andrew Le

Can this New Health Service be the New Google of Health? with Dr. Andrew Le, CEO and Co-Founder at Buoy Health

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing health care thinkathon. That's outcomesrocket.health/conference.

: Welcome back once again to the Outcomes Rocket podcast or we chat with today's most successful and inspiring health leaders. I really thank you for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's guest because he is an outstanding contributor in health. His name is Dr. Andrew Lé. He's the CEO and co-founder at Bouy Health. At Buoy Health, they're leading the care tech movement. As opposed to the prevalent view that artificial intelligence and technology is something to be feared, they believe that technology can provide care for people with that aim, they're creating a computerized concierge doctor to provide personalized medical information in place of late night Google searches and scary internet forums. At its core Buie is a machine learning adaptive diagnostics generator with the ability to express compassion and humor and Andrew here is going to walk us through some of the highlights the things that they've been up to and the advances that they're making in artificial intelligence with Bouy health. So without further ado, I just want to give you a warm welcome Dr. Le.

: Appreciate that, Saul. thanks for having me on your podcast.

: Absolutely. So what is it that got you into the medical sector to begin with Andrew?

: Sure. I mean I've always dreamed of being a doctor so I learned from a young age just playing with some toy sets that my parents gave me. You know shots, toys stethoscope and ever since that age 5 I want to become a surgeon.

: Very cool.

: On a single track mind up until the fourth year of my fourth year of medical school until things kind of changed. Obviously I'm still in healthcare but not a neurosurgeon, in a very different career path.

: So what happened? What made you shift from neurosurgery to which you're interested in now?

: Sure. So I was doing my last rotation of medical school in the ER.

: Yes.

: And I was seeing patient after patient coming in having googled their symptoms before making a decision and ultimately guessing as to what they have in order to make a decision. And that gets very often being wrong and that leading to patients who are coming in when they shouldn't have or they were actively endangering their own lives by sleeping something off when they could have come in early and we could have done something less drastic.

: That's really interesting that it just kept happening.

: Again and again. And when you're seeing that you go into medicine thinking I'm going to be the frontline I'm going to be part of the first responder that, you know one of the first responders that gets people to do the right thing at the right time and seeing you know being in the E.R. you quickly realize that you're far from the frontline, the frontline is truly the internet.

: Wow.

: And unfortunately what tipped me over the edge to take a much more risky path in life was my dad he had a mini stroke right around the time I was experiencing this. And he didn't go to the doctor. When I asked him why did you call me or I have two sisters both in health care as a user are you guys working. I said okay, why didn't you google it? And what you said back was you know, what am I going to find on google? And it was at that moment where I knew I had to do something so I took a sabbatical school and started to believe about 5 years ago.

: Man and has everything turned out okay with your dad?

: Yeah luckily it was a mini strokes. His symptoms went away and...

: Thank God.

: Really good job. Thank you, appreciate that Saul, you did a great job persecute episode to take care of himself, doing great now. So, I appreciate you asking.

: Yes absolutely, brother. A blessing that he's okay but at the same time it's like you're getting struck here with a message from patients coming in and then eventually your own dad that just led to the tipping point of saying you know what, I'm going to do something about this.

: Yeah exactly. Exactly. And then once I got started doubting us sailing very low lows. Those highs we get addicted and I remember I went back to medical school to finish a few rush requirements and I went from being very enthusiastic about what I was working on in the hospital to being I could, I was counting down the days just go back to working on Buoy and scaling something that could really change the way people consume healthcare. The way people don't understand disease and ultimately the way that humans basically treat their own illnesses.

: That's super interesting, Andrew and I love your passion for it as you dive through some of the things that you guys have done there, what would you say is the hot topic that every medical leader needs to be thinking about today?

: I mean it sounds really trite but the thing I hear time and time again is about the consumerization of health care. And every time someone talks about that the next five presentations on the about or here are things that are helping the grease the wheels of the system that are servicing the system itself. So I suppose it's helping doctors, helping administrators, helping payers, etc. It can all of the different middlemen that access care. That's still a major driving force of startups these days. But I would say that when every time I do hear the word consumerization it's coming just like the travel industry was offended by the ability for patient you know for people, people to take control of how they travel. People are going to take control of how they consume healthcare and it's just a matter of time.

: That's a good good analogy. I think we oftentimes forget that disruption that has occurred in industries like travel or even the taxicab industry for that matter I think that's more of a common one. But as you think about consumerism in healthcare what are a couple of things that you'd highlight for the listeners that are important?

: I would say that we really focus on and we really start to understand the is the care decisions. So how patients make decisions about what to do when they're sick is something that has been really ignored for the most part. And let me kind of go into that, to use the analogy of going to the mechanic. The demand for healthcare is very similar to the demand for car repairs in that as of right now it's dependent on an expert telling you what you need. So just as you're going to mechanic, the mechanic tells you need X Y and Z service for your car. It's very hard for you to say otherwise because you don't have expertise in understanding what it means to have X Y or Z broken them in and what it means how to fix. And similarly when patients are trying to consume care whether they go to a walk in clinic you know CBS walking in a clinic and urgent care, in E.R. A PCP, a specialist, call a nurse line, whenever they're essentially trying to access an expert in order to understand what is the next step in order to get them healthy again. And as healthcare. With the proliferation of a telemedicine nurse call centers and even building as many mini clinics and urging care as possible. They're trying to scale the access to those experts in order to help better control that care decision. Now I would say that consumerization will come in the form of better more scalable ways of helping patients make better informed care decisions. And so when we think about what we're doing essentially you could boil it down to. We're providing patients super personalized facts and information that guides them to do the perfect next thing that's going to get them healthy. And in doing so that's going to allow nurses and doctors and care coordinators and health care coaches to really practice at the top of their licenses and to enable to offload the burden of guidance and care decisions away from experts and do it having more scalable AI.

: Fascinating. I think that's super fascinating, Andrew and this is sort of like bringing the power of decision making very specialized decision making, health decision making to the consumer. Can you give us an example of how you guys are doing this at Buoy health and maybe a success story something that you guys have done to improve outcomes?

: Sure. So how we work, we have two different offerings and we have Buoy free and then we have an enterprise solution that we license to hospital systems, payers, self-insured employers, universities, governments even. And just kind of breaking down the two different use cases and talking first about Buoy free, so we released a free version of our product back in March 2017 and by the end of the year we had 2 million users. And this year brought Pacer somewhere between 20 and 50 million users

: Wow. That's exponential.

: Oh yeah. No I appreciate that. And in the short term what these users enables us to feel our machine learning. So the more people use it, the better the product gets. It also enables us to iterate on changing behavior. So like I said we're trying to help people make better care decisions and what that means is if people's baseline ability to make their decisions is core which I would say I there are any number of statistics that support this. The number of ER visits that are unnecessary. The number like we always post is 56 percent. The number of urgent care visits that could have been taken care of and telemedicine a number of primary care visits that are referred to as specialists that are needed by patients that are really are necessary in such at 50 percent. So I would say first off that are under people's underlying to make great care decisions as of right now is low. And as we began to optimize Buoy free what we're optimizing is presenting information in a way that gets people to make better decisions. So that's the purpose of having Buoy free. And the enterprise what we're licensing is the ability to customize the end up point. So if we're educating this person that urgent care is the right next thing to do. Right. From a health system perspective can I now maps this person to the urgent care that I have available and then let them know here's where you should go. And now you have this end to end experience where someone went from being sick and uncertain and scared to being informed and now being empowered to actually take action into the action. So that's what we're working on right now in terms of outcomes and what our success rate is with our early systems that we deploy, we have two systems that are alive right now. What we've been able to show is that we are capturing patient information when enabling a booking at about somewhere between 5 percent and 20 percent of time for patients which it doesn't sound you know if we're to create this on a zero - hundred ABCs scale it doesn't sound great but if you consider that this is a self-served mechanism with no need for human intervention it actually is a huge percentage of the time where we are unable to enact some sort of behavioral change which for us is a super exciting. As you know it's those incremental changes in behavior that really have huge benefits. You know when we played out over millions and millions of people in a way where the marginal cost of the solution is zero.

: Andrew that sounds really interesting and so as you guys continue to be scaled a product, more people are learning about this. How does somebody typically find their way to Buoy? Are you guys doing marketing or are you guys doing word of mouth like what's that look like?

: It's a combination of word of mouth and inserting ourselves into the Googling process. OK so we understand 72 percent of americans Google their symptoms first before they do anything else. And for us to want to change that habit it would it's in our opinion that it's foolhardy to just market the heck out of this and say yeah you know next time don't Google, go to Buoy. Especially because most of the time that that marking talk is going a healthy ear, a person who is healthy.

: Right.

: Our other kind of like real Corton is that people tend to not care about their health mostlike to be sick. So you put those two causes here first when you're sick or googling first. Second, if you're healthy you really don't care about healthcare. The concept of blasting using Buoy everywhere means it's we're not going to have a lot of success to get people to go directly to us in the early days where we really need to do is insert ourselves into the habit itself. So we actually are optimizing finding Buoy on Google and that's how we're driving a huge percent of our traffic. And then over time as you will have a great experience. What we're hearing is a lot of word of mouth growth. For now people are going direct. So it's a real combination of first inserting ourselves into the due process and then writing such a better experience that people end up coming to us directly over time.

: That's cool and eventually hey you know if you guys keep doing what you're doing rather than say hey why don't you google your symptoms. They're going to say why don't you Buoy your symptoms.

: I mean that that's actually with our of our friends of family and people who write to us on our support line that's literally like what they're saying today. So I'm a doctor I used to get phone calls all the time from my family members asking me for stuff. And it's only now I only get phone calls after they Buoy-ed it. And so they'll go and they'll call me and they'll know like they won't asking questions or saying hey check Buoy, Buoy said this.

: I love it.

: Whata are you thinking? Feels great because I told me my family and my dad was sick and now these companies built something that is helping people I love so it's super gratifying.

: Nah it sure is man. And kudos to you and your team for challenging the status quo and doing things a new way. I think it's super super interesting what you guys are up to. Take us to a time when you had a setback or a failure and what you learned from that.

: How long is this? How long do we have? I can start with I guess one of our dramatic failures. We went without cash for about nine months at the beginning from when the started founding the company. And about two months in to those nine months I was working out of our, I was living in my apartment and my co-founders were actually crashing and we were using the Harvard innovation lab as office space and my apartment burned down in a fire.

: No way, are you serious.

: Yeah seriously. My co-founder is actually were picking through the ashes like the ruins apartment with the salvors message. But you know they went back to their respective apartments in other cities and I basically chopped surfed for a solid 3 - 4 months so I was like literally homeless you know trying to get this company on the ground with no funding. At the time.

: Nuts.

: So I mean what I learned from that is let's go back let's say the company fails and back. You know just car surfing what a ride. I was already at point. There's only. There's nowhere to go but up. There's a lot of times when I get faced with issues on a daily basis just think that well. It just puts everything in perspective.

: That's for sure and you know the other thing too. I think what you learned Andrew is that commitment that you had to the cause.

: That's true. That's the way you put it Saul.

: You know because if you, if you didn't you would have quickly found a way. Harvard M.D. yeah you've got a lot of ways to make money and so you decided to stick through it and now you guys are moving and shaking and things are looking more promising and even more promising each year that you guys go through it.

: I appreciate it Saul.

: Absolutely. So what would you say one of your proudest leadership moments to date that you've experienced with Buoy.

: I would say there's a couple of moments that really stick out. One I kind of alluded to this earlier but one of my aunts she had some chest pain and they were worried that she was having a heart attack and her son, my cousin basically said Oh let me Buoy it first. Buoyed he did. And Buoy ruled that it was Costochondritis, which is inflammation, the joints that connect the ribs which is really common in something that often gets confused with the more serious. My aunt didn't have the right wrist back to profile to really warrant it nor like does the race entomology that we decided was this doesn't look like something carby after an orgy. So she decided going instead of going to emergency room at 2am to wait till the next morning to her primary care doctor who kind of confirmed what we had said. And my cousin relayed that back to me at the time we didn't have you know, we didn't have users, we're still in the family and friends phase of Buoy. I remember being getting very emotional and just saying we went through all of that. Been at it for at that time 3 - 4 years and honestly I felt like I could have you know we could have failed that day and I still didn't have because we instilled something that help the family member. At this point if we just leave the servers on and just walked away and lay down and be implanted somewhere we would just passively be helping people forever. That just so gratifying to to be able to that to a point where we could help some people. There's always more things that we can improve on and get better at.

: That's fantastic and I'm sure your family was grateful to the resource.

: I hope so.

: Hey so so Andrew you tell us a little bit more about an exciting project or focus that you guys are working on today within Buoy.

: Right now we are really figuring out how intent changes. So it sounds vague but as I said you know we're really in the business of understanding and changing the care decision and one of the things that we really need to understand is actually how person's intent changes throughout the process. And so what we've rolled out that relatively recently is actually asking people upfront. You're here, what do you intend to do even before going through this process. Then comparing that with what they ultimately did in terms of you know where they seek care, what type of care, where they're diagnosed with and then really seen the delta between their original intent and what they ended up doing. And now that we have that close loop as I said we start to iterate with thirty eight thousand people on site day and figure out how can we make people make better decisions. How do we make them delta between what they intended to do originally was ultimately greater for us that super exciting. So moving the product the way beyond just something that can check symptoms does something that is really guiding people on their journey. Having a real measurable impact on patient behavior is that next step.

: That's very insightful. I think it's given them what they were looking for even though they didn't exactly tell you what they were looking for.

: Right. Exactly.

: Andrew, that's so cool and big kudos goes out to you and your team for continuing this journey. I also personally believe that AI is augmented intelligence not something that's going to replace so I'm there with you guys I'm going to be rooting for you on the front line. And so let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine. It's the 101 of Dr. Le. And so I've got a syllabus that you and I are going to construct through a lightning round. Four questions followed by a book and a podcast that you recommend to the listeners. You ready?

: Sure.

: All right. What's the best way to improve healthcare outcomes?

: Think about the patient outcome in the most transparent kind of truthful way possible.

: What's the biggest mistake or pitfall to avoid?

: Assuming that if you built it, they'll come

: I love that one. Those bad assumptions made so much isn't it?

: Especially in healthcare.

: Oh gosh. Love it man. How do you stay relevant as an organization despite constant change?

: I mean it sounds trite but to continue to a line every piece of strategy every piece of work to improving the patient journey.

: What's one area of focus that should drive everything in a health organization?

: The patient. I'm sorry that must be so boring.

: It's right. I mean it's good. It's good. What is it you know these are intended to just bring out what's at the core. So listeners you very much well know what Andrew here is focused on and why he's doing what he's doing on this syllabus Andrew book and what podcasts would you recommend to the listeners.

: Yeah if designing a syllabus, I would actually read Shoe Dog its autobiography by Phil Knight was that founder of Nike and how their singular focus on the runner the athlete was the main driver of their success but then also just reading about all of the problems they faced to build. Such an iconic company kind of take for granted how powerful and influential they are now. At one time they were reselling asix. So it's such a cool great story really moving in I feel like it would apply to what we're trying to do in healthcare.

: That's awesome. And how about a podcast?

: Besides yours. Besides yours is probably a pretty basic answer but I'm a huge fan of NPR's How I built this. In every episode you hear about kind of in a similar vein a shoot out of fearing who they really are representing and then basing all of the naysayers and all the reasons why they shouldn't be doing something for somebody and then them overcoming it. I listen to it every single day when I walk to work. Just. Kind of get the juices flowing.

: Awesome. Some great recommendations listeners please take note of these things by going to outcomesrocket.health/andrewle. It's Andrew and then le. You gonna find all the show notes as well as links to the books and podcasts that he recommended in this short syllabus that we constructed for you. Andrew, this has been a ton of fun. Before we conclude I love if you could just share a closing thought and then the best place where the listeners could get in touch with you or follow you.

: Sure. Are we just kind of close. Simply by saying that we hear all the time that health care is broken and I think where I came to it was either I was going to continue to be a part of the system that was broken or I was going to make some incremental change or difference. I hope that the listeners choose the of the latter group no matter where they sit right now within healthcare and they can reach me directly andrew@buoyhealth.com my email or my Twitter's andrew_q_le You can find me on Linkedin as well. Our website www.buoyhealth.com.

: Outstanding Andrew, appreciate that. And listeners take Andrew's call to action. Get on the active side of the equation and do something for health care like him and his founders have done. Andrew can't tell you how much I appreciate you spending time with us today and we're really excited to follow you and your company success.

: Thanks so much, Saul. I really appreciate you having me on your podcast.

Thank for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book and Podcast:

Shoe Dog

How I Built This

Best Way to Contact Andrew:

andrew@buoyhealth.com

andrew_q_le

Andrew Le

Mentioned Link:

https://www.buoyhealth.com/

Episode Sponsor:

Outcomes Rocket - Gaspard de Dreuzy

How to Combine Artificial Intelligence and High Touch Improved Outcomes with Gaspard de Dreuzy, Co-founder and President, Pager

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing health care thinkathon. That's outcomesrocket.health/conference.

: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I really thank you for tuning in. And I welcome you to go to outcomes raket health. Slash reviews where you could leave a rating and review for today's guest because he is an outstanding contributor to Healthcare, an entrepreneur and a man that wears many hats. His name is Gaspard de Dreuzy. He is an outstanding leader at Pager. He's a co-founder and ex-CEO currently still president on the board of directors. He's done many other things in other companies including being the co-founder and director of trade it. It's trading tickets incorporated as well as co-founder and CEO of capital and the list goes on and on. This gentleman has done a lot for healthcare and what I want to do is welcome him to the podcast to really cover some of the topics and exciting things that are going on at his latest company which is called Pager. So without further ado, Gaspard welcome, my friend.

: Thank you and thank you for having me.

: It's a pleasure it's a pleasure. So what is it that got you into health care, Gaspard?

: Well I mean as you kind of said in your in your intro, you know I've been an entrepreneur my whole life. And I really love going into new industries and new adventures and really with an angle of you know how can I help innovate and disrupt the industry either through technology or through user experience and design. So I think that's the real story about Pagers that I'm french and I grew up in France and colleagues. As I was growing up we had these service called SOX medecine means doctor in French. And SOX was media and very important service in the healthcare landscape in find that having doctors to your door. So basically a household system that managers really all the urgent services in France and you know today they do maybe six or seven million visits a year just in France which is pretty outstanding. And I realized that we didn't have that kind of services here in the US. Atleast not on the major scale. And we decided along with my two cofounders. One of them was one of the founding members at Uber, so he apply that knowledge to healthcare and really tried to in a way come up with you know what it is today for healthcare on demand. So that's where we're definitely a big inspiration for the early days of pager and then obviously it's often the case when you sell the company within for developing you know a more refined vision then they will go over time.

: Now that's super interesting and you definitely have a strong leadership team there you've got Walter Jean, Oscar Salazar and Philip Eytan. I mean you guys are moving and shaken baby.

: Thank you. Really happy about the team and yeah, Walter who joined the company about a year ago it is more than a year ago it really came as a great addition to the team because at the time we were really looking for someone with more healthcare and more healthcare experience.

: Yes.

: Oscar and Phillip and myself we've all been technologists and entrepreneurs that none of it came from the healthcare industry. My experience was more and initially in the video gaming industry and then in industry. Oscar, you know technology is coming from you know Uber that is just before before Pagers and Phillip was more on the financial side you know with experience that companies that are Gozal Morgan Stanley. So we all have own background but it was great to see words are coming and joining us to really bring some more of this is a health care DNA to the team.

: Now that's really awesome man and you know the thing about health care is that every industry touches healthcare so whether it be Uber, hey we got over health now right or whether it be the finances behind it, it all touches it. And I think the great pool of experience that you guys have will contribute in a big way to the success that you guys have. Yeah.

: I mean I definitely agree with you and I would say that you know the alternate view is that industries like transportation or finance or and obviously healthcare are very large industries and very heavily regulated industry. And that's the way to innovate in those industries is that all point of view and that's our angle is to try to improve the quality of the user experience. I think Uber is a great example on how make it more simple and make it more easy and fast to get transportation on demand and everything that I've tried to do the same thing in finance and now in healthcare. So those industries have that in common that they are big they are difficult to move but to come in with a real design centric and user experience driven vision you have a chance to really take them to the next level and really disrupt them.

: Now it's such a great point. Gaspard and it's just here's an example of a group of folks you and your team that have gotten together to become the digital Davids so to speak in an industry with huge Goliath's and so I'm excited to see what you guys do in that in the next coming years. What would you say is a hot topic that should be on every medical leaders agenda today?

: I mean there are a lot of topics but obviously for us and this is the one topic we're always talking about and kind of trying to bring top of mind with all industry leaders whether they are providers of payers and obviously the consumers. Is that you know they sort of are the consumers what we see on the consumer stand point. Health care is very confusing and very fragmented. People I'm sure you and I are the same. You know we have a lot of different providers different kinds of needs depending on how we are and where we are and what kind of conditions we have. There are a lot of options in terms of care. Available are there you know from urgent care to ER, to primary care, specialty care, to virtual care and on and on. So I think that's the main topic. The one that we are very much passionate about is how do you take that very kind of extended and therefore choosing and usually fragmented healthcare ecosystem and make it more easy for consumers to access it and to navigate it. And that's really what we're very much as I said passionate about and trying to solve this page.

: It's a great opportunity and listeners were faced with archaic processes and archaic ways of doing things. If we do not change, then others will and Gaspard and his team over a pager, they're finding ways to become more efficient and lean. So it's really the onus is on us as leaders of the healthcare system to take action and make corrections and think outside the box. I love that you brought your experiences and ideas from France over here and just apply them in such a way that would help us get better health care so I love that you have that inspiration from Europe.

: Thank you. And I think you know the French shopgirls ecosystem I know if it's better or worse than American system I think. I think it's not black and white or something things better or something has a way worse. But again as a consumer in France you know growing up there it was very more easy and quick to access the healthcare system and it was a good starting points for us as a company and also to help us to build a vision. But what is really amazing in the U.S. is that we come up with that vision in the US market and then from there we just evolved a lot and I think that actually I was very pleasantly surprised that the healthcare industry and the healthcare ecosystem in the U.S. seems to be very open and very in a way very eager to innovate. And you can see that with the evolution of Pager. As a company we really started a little bit like I told you with the French vision around kind of care delivered on demand right. How do you get providers in people's home to really make it more kind of consumer centric to access urgent care on an on demand basis. And from there we realized that actually the biggest of opportunity was really to provide better access and better navigation to really help people, to help guide people through the complex healthcare ecosystem because if you look at the healthcare ecosystem in the US is very rich. You have so many options available for consumers and we think it's a it's a great strength. And the problem was all those options available is that it's just very difficult for consumers to know where and when to use what options. And so we realize that our DNA of the day really care on demand and being very consumer centric, what the right DNA but that's the way we're doing that through housecalls and the that that was not enough. So we decided to really gonna become you know more of a kind of a single entry point letter form door into your healthcare or the U.S. you know use Pager to actually ask questions and get some help and get guidance to the WidePoint of care. So we see the DNA but I think that being in America allowed us to be extremely flexible in terms of evolving our vision and evolving how we would execute on our vision and I think that's the big strength here compared to France where things are way more you know a little bit more heavy and less flexible in the way people just innovate and start companies.

: I think that's so great. Gas Bardin and listeners I want you to just take a nugget of wisdom here for a second and just kind of soak it in because we oftentimes are held back by our own false beliefs and I believe that one of the false beliefs that exists in health care in the United States is that it's inflexible and when in reality it's not. You just got to find the right people to help with whatever you're trying to do and Gaspard and his team have done this, Gaspard. You bring up a really great point right. I mean you were surprised with how flexible things were.

: Yeah and you're actually right I think you know a lot of people in the industry are thinking about the challenge of accessing care and I think we think that that's not necessary the challenge led to your point people have a lot of options available. There's a lot of activity in the system and urgent care to your primary care doctor to ERs. A lot of things are available. What is more kind of challenging is the fact that these industries extremely fragmented so no one except sometimes your primary care doctor is going to be acting as your kind of your guide or your front door into that ecosystem. And the fact is that all those options are available. And the fact that you have all this flexibility means that it sometimes gets really confusing don't know if you're sick so you'll just go on google and do your kind of your self care so you call your primary care doctor who usually very busy and not easily available to you on the way. So you go online and try to find another doctor and get your appointment who you go to and your to go to an urgent care center to try to talk to the doctor to pull or chat. I mean just so many things the problem is...

: So many things.

: People are not just kind of qualified to make those decisions. And I think that you have companies, life into who were trying to fill that gap right. Trying to just guide consumers through that complex confusing because flexible paper system.

: Well said my friend well sad and health care is not something that unless you have chronic disease right you're consistently in and out of the hospital. And that's one thing but the majority of people don't interface with health care until they need it. And so it's kind of like I go to Denver a lot. So whenever I go there I don't know it very well. But I always go to my concierge and he lets me know where I can go for a run. He lets me know where I can go get some food. And he always points me in the right direction and the service of a concierge and healthcare doesn't really exist. I like that you that you brought up the fact that your primary care would be the closest thing to that and it's really cool that you guys thought about this and made the shift from a point of care solution to something broader.

: And I like actually the word concierge and you know content in health care is a little bit risky to take concierge because you know health care is horrible. But to your point you know we're trying to offer a wholesales like experience to the patients and to the consumers and work for them to be here when consumers need us. But that's what we're trying to do and what we will be trying to do for the next phase is to also be there when people don't know they need us. How can we at some point offer a more proactive and a more personalized experience to the consumers because at the end of the day you probably always need to interface with healthcare except that people will initially do it because they don't literally know that anything to interferes with healthcare and also they don't literally live who interface with healthcare right.

: Right.

: I think that the next kind of the next challenge down the line with Pager now that we're here when people need us is to be here when people don't know or don't think they need us and try to be their companion or the host shares in a more consistent way. That's going to be a challenge for us and we already have so much. We're also the company that is dedicated to address that. That's pretty exciting so.

: That's super exciting. And so with the changes that we have coming in increased sharing right we've got the laws coming into effect in 2019 requiring these big EHR, EMR systems to have and sort of like an export using fire or whatever else they could use. A patient could upload their information to you and maybe you guys could give them some insights that they didn't expect.

: Yeah I think that's a long term vision not a hundred percent agree with you. I think that before it becomes a reality the question is where can we find the data off sooner or earlier. And I think that one of the answers is work with the providers and worst of payers life. That's one of the reasons where we started as a kind of a direct to consumer company here in New York and then over time we've evolved as our model was evolving. We also evolved in terms of focusing more on payers and providers today that's really our focus. We be working with partner mostly with payers and also with providers. And one of the reasons why we do that is because by doing so we can integrate with our system and thus integrating with their systems. We had access to data and power. I was talking about this more a proactive and personalized care engine because of you know the data can do whatever technology you all and God knows that I figure we're dedicating so much resources when it comes to artificial intelligence and kill management for example. But without the data nothing can happen. So what we have we decided to do was to work with. As I said payers and providers and tried to have them could open up. So that we can have access to some of the data and use that that are to train our AI engine to care for patients in a more proactive and more personalized way moving forward.

I think that's cool, Gaspard and you know I'll you just right now. I believe that that healthcare providers are really wanting to know how to use the technologies that exist out there and with partners like yourself at Pager. I think it's going to be a solution that a lot of people are clamoring for and the opportunity for pilots that could grow into a bigger things could be very exciting. And so I think it's it's a really great focus that you guys have.

: Well thank you and I think that we've started the process you know we have many partnerships in the works. The most interesting for now for us is big strategy property that we have with Horizon BlueCross BlueShield of New Jersey which is a very important partner to us and we're learning so much with them and hopefully vice versa. And I think that a lot of negative in a lot of providers and payers needs to understand better what are the existing solutions are there to help deliver a better user experience to their patients that are members. And I think that for your audience and you know in a good way to kind of understand what the difference between pager and other solution is the that are really our focus is to deliver the kind of to your point cochairs life experience and the way to do it is by building technology but combining technology with actual humans we believe that automating the entire care navigation and ordination process with technology is not the right way to do things today because technology has a tendency to be very intimidating to consumers. In healthcare you know this is the house where there are usually very skeptical about and sometimes care about technology. So what we decided to do it was really to put nurses on the interface between us and them and really build technology to empower to enhance the powers of those nurses so they can better serve the consumers. So I think that that's really talking about total solutions on the market. The specificity of pager is that if that we're a services company in the way that we have a command center with a lot of nurses working and we really caring for the patients and for the consumers and that older technology that we've built is to actually empower the nurses to treat or should I say to try to assist those patients in a better and faster way. So I think that would be a good kind of edge for you or just understand about pager.

: That's definitely a great distinction because part and had I think anybody listening to this can relate that if you call in and whatever it be right you call that 1 800 number and you get a machine that asks you for different prompts. There's nothing more frustrating than that especially if you're going to be wanting to deal with your health. It's nice to have that human touch and it sounds like you guys are keeping that care and health care and not just mechanizing the whole thing.

: Yeah. And I think hundred percent absolutely agree with you and I think that you know machines are. And we love machines that major because we just want things that are good for interacting too much to the consumers. And also we believe by the way that most care decisions whether you should go to an Yarm should an urgent care or to go to yes or care like a FaceTime consultation with your daughter. All those decisions to be human. We don't think that machines have proved yet that they are better than humans to make some of the public services. So I think that the level of comfort for consumers to interact with a licensed nurse and knowing that the technology actually makes the nurse better. That's what we think is the right model for the foreseeable future 10 20 years from now. We shall see. Right. But what we believe is that today it's really the combination of human and machine with humans needs to be first in line the mission is to be working in the background to enhance the human powers.

: I love it. I think that's such a great point. Gaspard talked to us about a story a time when you had a setback or a failure and what you learned from that?

: I think you know as an entrepreneur and millions I'll tell you how I think I hope I kind of learned and use that figure as an entrepreneur in the past. You know I've done by whose companies and it happened to me especially for the first version of our products usually over investing time and money and energy. Building the first iteration of the product. Now so we were launching it and really putting in the hands of users. And I think that that that is extremely dangerous because it's expensive and in a way you don't really know if people are going to welcome your product. And so it's just a very counter-productive way of doing things and I've done that in the past. Actually more than once and when we started the pager I'm actually pretty happy because we decided to be way more agile like we weren't going to market very quickly was kind of this. There was mentioning before the kind of urgent care on demand products which was a very narrow focus on one use care, right. We went direct to consumer because we didn't want to wait for people to just start testing our products. So we ignored payers, we ignored providers. We did everything ourselves. And we were lucky because we were able to access financing to fund that. Not cheap is actually pretty expensive.

: Yes.

: We went there quickly with a product that was not perfect and they said direct to consumer and he told us to learn extremely fast. And that's why after we were able to evolve and our product or the last we didn't kind of stay rigid on our initial decision to share products. We were extremely effective all the way the company's vision and the company's product and the company's business model evolved. And I think that's one of the reasons why the company is successful today and obviously it's not necessarily easy to do because being so agile actually this time and he cost money and you have investors or partners who are patient enough to support that profit when you are when you can make yourself when you can create an ecosystem of partners and investors who support a process that is usually a winning formula that takes time and healthcare everything that time it is way more powerful to actually launching a product in pulling that process. And I think that as I said you know I did some mistakes in the past because if you don't follow that with major. We did it and I think that paid back to them.

: That's so great. Gaspard and listeners take this jam and practice it don't create your products or services in a vacuum. You've got to get out there even though it might be a little bit more expensive like Gaspard said to iterate and to shift while you're going out there getting feedback. It's even more expensive if your company fails. So definitely a great pearl of wisdom that you share with us. Gaspard thank you for that. So here we go. We're heading here toward the end in this little section. It's a lightning round Gaspard so I got four questions for you. It's the 101 or the ABC is of Gaspard in healthcare. And so we're going to put a we're going to put a syllabus here for the listeners and we're going to follow that with a book and a podcast that you recommend to the listeners you ready.

: Yeah.

: All right. What's the best way to improve health outcomes?

: The best way to improve how outcomes I would say is to always partner with the provider that you need right. So it's really key to always find the right providers for what you need.

: What's the biggest mistake or pitfall to avoid?

: I think I just mentioned one was isn't the focus or the biggest mistake is to spend too much time building a product and developing a vision without actually putting it in the hands of of your users and your partners.

: It's powerful. How do you stay relevant as an organization despite constant change?

: Same thing you know being always flexible and not be attached or emotionally attached to your initial or to your old ideas. Always be ready especially as an entrepreneur to people or change or enhance or change your mind. And change is usually a little bit difficult especially for large organizations but also very difficult for small organizations because that means that to change direction you need to retool your team. It is essential business model but change is usually good it's not bad. So what we really you know look at change, the good thing about thing.

: There you go. What's one area of focus that should drive everything in a health organization?

: It depends on the health organization like you know it's your provider the quality of health and safety of your providers is absolutely key. I would say for an organization like Pager which is early stage which is really about user experience it's just your manual focus on the quality of the consumer experience they work for us. That's absolutely the thing that is the most important.

: Love it. What book would you recommend and what podcast would you recommend to the listeners?

: That's a good question. The book that I would recommend is a French book called Gaspard de La Nuit which is you know the book of the same name but a book that you know kind of pushed me a lot of interesting lessons when I was younger and comes of having space or adventure and risk which I think is the foundation for being an entrepreneur. And in terms of podcast, you know like a lot is built by NPR podcast by and from them from entrepreneurs who was your ideas about how those very creative and successful entrepreneurs actually built it. So that's the one that's I enjoy a lot.

: Beautiful. Listeners, don't worry about writing any of this down. Just go to outcomesrocket.health/Gaspard, you're gonna find all or shown out there a transcript to everything that we've talked about, links to the books and the podcast as well as a link to Pager. Gaspard, this has been a blast. I really enjoyed our time together.

: Thank you it's been fun. Thank you so much for inviting me.

: Absolutely. Unless and before we conclude I'd love if you could just share a closing thought and then the best place where the listeners can get in touch to collaborate or follow you.

: Very interested to Krassner with new organizations and new people and conforms to our vision and obviously show our product and again make it evolve and make it better all the time. Those are the best way to reach me just a gaspard@pager.com

: Outstanding. Well go ahead include that for you listeners in the show notes so be sure to check that out at outcomesrocket.health/gaspard. This has been a pleasure. Really appreciate you taking the time to be with us.

: Thank you so much. My pleasure.

Thanks for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.

Automatically convert audio to text with Sonix

 


Recommended Book and Podcast:

Gaspard de La Nuit

NPR podcast

Best Way to Contact Gaspard:

gaspard@pager.com 

Mentioned Link:

https://pager.com/

Episode Sponsor:

Outcomes Rocket - Peter McCaffrey

A Novel Approach to Cancer Treatment using Artificial Intelligence with Peter McCaffrey, Biodesign Fellow at TMC Innovation Institute at TMC Innovation Institute

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing health care thinkathon. That's outcomesrocket.health/conference.

: Welcome back once again to the outcomes rocket podcasts where we chat with today's most successful and inspiring health leaders. I welcome you to go to outcomesrocket.health/reviews where you could leave a rating and review for our outstanding guests today. His name is Peter McAffery. He's a Biodesign Fellow at the Texas Medical Center Innovation Institute and a TMC Innovation Institute. And he's doing some really great things. He's a physician a data scientist a medical inform assistant entrepreneur who believes that data fluency and artificial intelligence have the power to heal healthcare and the lives of patients it serves. He's doing some amazing things his background as a as a physician and clinical pathology from the Harvard Medical School and he's just got some really passionate beliefs and is doing what he believes through his passion in this program. And I want to introduce this amazing gentleman to the podcast. And so Peter I wanted to welcome you.

: Thank you, Saul. It's great to be here.

: Absolutely. So so maybe you want to fill in any of the gaps here that I may have introduced in intro.

: Sure I know you a great job I was interesting. Trivial fact. I come from a humanities background. I don't have formal training. Science we can get into it or I think that gives a different kind of a unique perspective when you approach those kinds of skills a little bit later in life and how you use them to find value. But I've been involved in both operations, analytics and healthcare analytics as well as bioinformatics I've kind of done a couple of different things and had had three companies in the past have been involved with. So a lot of interesting war stories to draw from

: Love it. And they were excited to go through that. Never a dull moment with Peter McCaffrey. Ladies and gentlemen and so Peter that's pretty cool them humanity side. I also well my my undergrad is in classical humanities. What was yours?

: Wow and I was an English literature and philosophy.

: I love it man. And everybody is always like why. Like why. How are you in healthcare. And so that lends very well to our next question. Peter, what got you into the medical sector?

: That's a great question so I started out deliberately not wanting to be in health care and I was in high school I was I wanted to be a musician. I was more a creative type and I was always told this'll probably resonate with you and perhaps some of your listeners that you know I was always told that there is this split you know that people who are creative do arts and people who are quantitative science and they're kind of just separate things. I can testify that's not so true. You know I got into humanities because I just I liked it and it seemed open ended. But what it really teaches you how to do I think is to think about things of philosophy as well literature you know your skill isn't analyzing stuff. And so it was with that joy of doing that loving that kind of thing that I had. I decided to try a couple of health care experiences you know shadowing I went on a couple of medical mission trips and it really struck me that healthcare when approached the right way is a really analytical field. You can be creative. It's not just number crunching. So seeing I could add my interest in analysis with impacting real people's lives. I thought this is great and I haven't looked back since I was a good decision to go into.

: That's awesome Peter and I love the way that you kind of laid that out. You don't necessarily have to. If you're artistic you don't have to stick with the art you could go into science and you're a great example of that and I never thought about it that way you know we spent a lot of time analyzing Greek literature and like you had to in order to make sense of it you have to be analytical.

: Yeah absolutely. And to formulate arguments you've got to put evidence together and make conjectures you have to articulate them just like he should do many things.

: That's so cool. So really glad and listeners I know you remember we had Joowon Kim from the TMC Innovation Institute. She and Peter as well as a couple of other folks are working on their company there and so Peter, thank you so much for making the time to be on here. Oh absolutely. Thanks for having me. You know yeah it's fun. So tell us a little bit about what you guys are working on. Peter I know the episode with Joowon we launched it. She was talking about kind of how you guys narrowed into an idea so maybe you could take us a little bit more into what you guys have evolved into.

: Absolutely. So the two second recap of kind of how we got here is that the as bad is on fellows. We spend the year July - July identifying unmet needs prioritizing down and then finding one and then start trying to solve that basically. And the needs that kind of bubbled up to the top for us both because they're important but because we liked them and thought they were interesting and a mixture of a lot of things were really precision medicine oriented needs. And so we kind of focus on the problem of being able to identify patients who will respond better to cancer therapies kind of as our as our first problem. But we solve it in a way that we may have the ability in the future to help patients respond better. So it's predictive. We can also do therapeutic things and we do this through a focus on basically DNA analysis using machine learning.

: Super interesting and this is a hot topic. A lot of people are talking about precision medicine and you had several guests talking about it. What are you envisioning Peter will be this is a hot topic right this is what you're thinking is the hot topic so how are you guys addressing it differently with your company. And what are the outcomes a potentially get from what you're doing?

: That's a fantastic question. So traditionally and this is near and dear to me as a as a pathologist you know traditionally we thought of cancer as these big buckets that were kind of largely defined by what things look like or where they came from. You have a lung cancer, you have a skin cancer, you have kidney cancer. And we're realizing that's not really accurate your cancer is very personal. It's very unique. It's really described by a whole lot of measurements about genomic and what they look like and what your history is. So our kind of unique angle on that is that recent research has shown kind of yet another angle through which cancer can be looked at and through which its behavior can be described. And that's through what's called the gut microbiomes I can get into that in a second there. But we look at these bacteria that live in patient's guts that they basically do things to the patient's immune system do things the drugs that they take. As we look at the DNA of those bugs and we say what's going to happen to this patient with their drugs. Can we change that microbiome? Can we make them do better? Can we achieve better efficacy for more people?

: So you guys are looking at. And that's fascinating right. I feel like there's been a surge of focus in the microbiome and now you guys are taking a pretty cool shift here in precision medicine for oncology. What specifically are you guys doing? Can you get into some of the specifics on how you could improve outcomes there?

: Absolutely. So it's kind of an interesting story in the way we look at this problem cancer care has changed a lot in a lot of ways. Used to be scalpels and radiation and generally kind of poisonous chemos and that still exists in large part. Then you had all the targeted therapies people cannot with their antibodies against certain things and now kind of the new I guess pillar or the new domain of cancer care is largely what they call immuno oncology. And what's interesting immuno oncology is you. You're trying to use the patient's own immune system to actually attack cancer because you're facilitating the immune system to go and do the work of finding the cells and beating them up and suppressing the tumor as it goes forward. So it's this kind of new wave of use in the immune system as a weapon against cancer. The microbiome it turns out plays a big role in how your immune system will behave. So what these bugs are what they are what they do how they act how they interact with your gut teaches your immune system basically to behave a certain way makes it active, makes it inactive. So we basically are an immune system profiling tool that allows you to make the patient more responsive to these immunotherapies.

: Fascinating fascinating and I'm assuming you're taking samples from the gut like how are you guys taking the samples.

: Yeah so we use fecal samples so you know they get micro biome is one of the very easy things to sample about a patient you take stool which has billions of microbial organisms in it across thousands of different species and you basically isolate all the DNA from that stool and that is just like a soup of DNA from all these organisms. The whole system in one sample and you sequence it and you end up with this just massive data dump of fragments of DNA from thousands of species of microorganisms that are all doing things and an ecosystem and you try to figure out from that who is there what are they doing. How do they relate to one another and what are these functions that they might do in this patient is driving their disease or driving their response. We rely heavily on machine learning to do that particularly in neural network and artificial intelligence analysis of those data to kind of get those patterns. But it's really pattern recognition of this very kind of broad shotgun sample of data from stool.

: That's fascinating Peter and and it sounds promising Yeah I was talking to a friend of mine and we got into this pretty deep conversation critical care. And how samples of like sublingual CO2 are just as effective at understanding patient's condition as if you were to put in I forget the name of that tool but you put it all the way into the stomach and it's just like all tied together and it's super intriguing that you guys are piecing this together to find out the efficacy of these drugs.

: Yeah it's fascinating because you know we're realizing that the microbiome is like it's like a whole new organ. If you look at you know a human being if there's take a person your genome has like 23 24 23000 genes basically. And yet your microbes that live in you and only you have over 3 million. So if you as a sort of whole organism are mostly bacterial genes and yet we don't know much about what these do and we don't know much about how we can like take control of their behavior and to achieve outcome. And it's ironic because you know Hippocrates thousands of years it goes you know all. What is something like all disease begins in the gut or something like that. And it turns out that unbeknownst to him exactly how that was true. That may in fact be much truer than we thought.

: That's pretty cool man. And that's kind of like how the humanity is here intersects with science and your perspective is really cool and I love this approach that you guys have taken just using new technologies and applying them in a way that will help treat these these very dangerous diseases. Cancer is a big deal. You know so many people die of it and if we have a more effective way of treating it you're making the world a better place. So kudos to you and your team my friend.

: Appreciate that. Thank you.

: Absolutely. And so we'll open up here for some more a little bit later listeners I mean definitely want to dig into this company and the things that they're up to. But I wanted to dive into some of your stories. You've been through several different companies you're doing a lot of great things in medicine. Share with the listeners a time when you failed and what you took from that lesson.

: Absolutely. So a harking back to kind of to other companies I worked on one was a a life sciences company was 2011 where I was the sole founder and CEO of a company called Accetia and we made a tool. We don't operate anymore with a tool called omic where you kind of design analysis pipelines for DNA in the cloud and run these analyses and then the analysis parcels in the cloud and it was all very exciting stuff. But I remember very distinctly managing that process to really important lessons came to mind. No we got funding to build a certain spec of this tool. We had deadlines, milestones, burn rate all those things although it ended up being okay when we finally were able to produce it and render it on into the institute we were partnered with. I did not do a very good job in my own opinion as identifying what of the many features was most valuable. And I think for anyone who builds stuff or manages people this is a hard skill to get right and a very easy skill to get wrong. I spent a lot of time saying well we can do all these things you can have all these features we can have you know this widget does that and this widget does that did not do a good time a good job of sequencing when you need to nail those things. And what is really important is you have to pare down things you do to be what are. If I could only pick two or three things that worked, what are those things going to be? Let me do those now only once those are done. You think about the other ones. And let me continually validate whether the things are valuable just because I think they're cool doesn't mean that they're worth anything. I think that's a I've gotten that on a number of times. That is a very important lesson to learn as you got to be open to externally validating get people's opinions. Pace yourselves and focus on sure fire easy wins upfront. Put fluff on the back burner.

: That's awesome. And what a sustained way of saying it Peter. Definitely a good take away listeners. We all are guilty of falling in love with our ideas. And in this area that we all work in of health it's so important that we huddy to Peter's point because if we don't a lot of time flies by your burn rate just will put you out of business eventually. But Peter your idea of just focusing on that one or two things if I had to throw everything else out the window. What one or two things will I focus on?

: Yeah that's key. It's tactical.

: And so these invaluable experiences. Peter I'm sure you're bringing into your new role here with the new company. Absolutely. What would you say some of the greatest things you've done and you're most proud of in medicine to date?

: So this would be kind of seems to be two years ago. Yeah so when I was a resident. A co-resident one of my good friends John and I we started a company called Hadera technologies. And our goal really was not bioinformatics it was operational analytics so we were you know clinical lab people we sit in the core laboratories of the hospital so it's a nice vantage point from which to do things like ops analytics because you see all the tesco and you see them all go out you see turnaround time you see ordering behavior right. So we thought this is really good let's build a dashboard, let's build a platform where you can easily get metrics and turn around and look at things and predict things. We didn't have a great insight into how complex deploying operational software in a healthcare setting really is and it was an amazing journey to say from when we decided we want to build this to fight it out a year and a half later. What I was really proud of us for is really going through getting stakeholders interested involved building will not cutting corners not going behind the back of a process doing it the right way through you know your security validation through your beta and pilot getting your spec looked dead by all the health I.T. department all the things that you have to do to really do healthcare I.T. and roll out something in a hospital. We kind of spearheaded and did ourselves and it was painful but it was great to do it and see that thing actually get turned on and it's still running and known and still does its job there and I was proud of us for pulling it off because you know deploying things in a hospital is not just building, building's critical but it's political. You have to be able to work with the organization you have to able to work people.

: That's for sure and layering in all the hipa and policies and safety you know cyber security is a very real thing. This is great. And kudos to you and your and your friend. Now you guys it's your legacy there right which you've done will continue to help them even though you're not there anymore.

: Right exactly.

: That's pretty cool. And listeners. This is another point right. If you look Peter was in the facility. You know he's a physician in the facility and it still took him and his friend a year and a half to get this done. Now I hope that tells you something. I believe that we could get a lot of unique thinking from outside of health care and we need it right we need it to make it better. And at the same time, don't think that you could build a business and be successful without the help of clinicians or the people your stakeholders. That's the number one mistake. Peter obviously you did it and it still took you all.

: Absolutely yeah. You have to work through people in hospitals as you know they are huge organizations they have a lot of moving parts and engineering is only one it's important. I would never devalue it but it's only one piece of very large pie and you got to kind of see it from the perspective of some other people too. I myself had a tendency certainly to be frustrated saying well you know what's the problem I built it it runs past tests. Why can't we just turn on. You don't consider that like from the perspective of the I.T. security guy this is the eight hundredth app he has to roll out and he didn't build it. It's not his baby. You got to get him invested enough to help him move forward. You got to work with people you know.

: Absolutely. And if you're a tech leader listening to this episode I am sure that Peter would love to connect with you and maybe share some ideas to help your company impact health in a good way.

: Absolutely.

: And then at the end of the podcast Piero's share his contact information so that you have it. Tell us about an exciting project. Let's go back to the idea that you guys are working on this business of the biome ans oncology. Give us an exciting focus that you're working on today with.

: Absolutely. So we're looking at how we can use the microbiome itself that profiles and signatures in the microbiome to tell whether an individual patient will respond to immune checkpoint therapy which is a category of chemo. And it's really fascinating because the way we were. What I like about it kind of geek out on the moment is we are we we are using neural networks to do this and I feel like machine learning and AI are very hyped and there's a lot of misapplication of that. But what's really fun about this project is that there's a genuine use case for why or why it would apply here. And it's just really exciting to even in what we've done so far. Prototyping to run these analyses watch that they do learn patterns and watch the patterns are externally validated in the literature. It's it's amazing that it mixes engineering and science and that kind of infectious like oh my goodness it actually worked aha moment you have when you when you first build something you see it complete. That we we believe the business case is good because cancer is a real and pressing illness and that these checkpoint drugs offer a lot of value and need to be enhanced. But we all just love. We love the tech too. We love working on it and we love watching the code deploy and watching the analyses run. It's just fun to do.

: Yeah. And even more fun part Peter will be when you guys start applying it and start saving lives.

: Absolutely. Yes. That brings it all full circle.

: That's amazing man. Thanks for sharing that.

: Of course. Thank you.

: So Peter getting to the end here. Let's pretend we're building our medical leadership course on what it takes to be successful. The 101 of Dr. Peter McAffery. And so we've got a syllabus here for questions and at the end I'd love to hear about a book and a podcast that you recommend to the listeners. You ready.

: Absolutely yeah.

: Awesome. What's the best way to improve health outcomes?

: I think you have to measure that to measure will measure everything you know where you are.

: What's the biggest mistake or pitfall to avoid?

: Honestly I think it's a tendency to have this reliance on blackbox tools. You can't Hirth analysis to just a tool you buy it and leave it at that you have to understand what's happening.

: I love that. How do you stay relevant as an organization. Despite constant change?

: I think you have to focus back on fundamentals. I think you have to make especially as physicians for medicine. You got to commit to knowing sharpening your skills knowing your chops knowing analysis knowing how to look at measurements and make conclusions and you stick to that. Everything else is subservient to that you'll be good.

: What's one area of focus that should drive everything in your health organization?

: So the way that we like to say it for us is you have to question everything and try anything. Never assume because a general opinion says something what works. But it won't work. You'd be surprised.

: That's beautiful. What book and what podcast would you recommend?

: Yeah so for podcast Cloudera. If you're into big data data science Cloudera has a really really great podcast we talk about cool their tech people from industry for a book it's interesting. One of my favorite books ever that I read in medical school actually is Dune Frank Herbert's Dune sci fi novel.

: Dune?

: Yes. Okay. The first one just because it tells a story of a guy who has all these what look like magical powers and it turns out that it's not magic in that universe. The guy has an ability to take information synthesize it and see the future. I think that's what we should think about health care like there's no magic here. There's skill and there is knowledge and we can all get there we can all do that.

: What a great great thought there Peter and listeners don't worry about writing any of this down. You could get links to Dune, Cloudera as well as all of the Q and A that we've just been chatting here with Dr. McAffery. You can find all of that at outcomesrocket.health/PeterM.. So Peter take us down here. Bring us to a good close. What would you say to the listener as a closing thought and then share where you could best be contacted.

: Then my closing thought would be medicine for all the great things that have been done in medicine and there's so much more that hasn't been done. And today could be the beginning of a life changing project for anyone listening to this. Go out there Google what you're passionate about. Learn a bit about it. Roll up your sleeves and get cracking and you can get farther than you ever thought. I can testify that.

: That's awesome.

: For my e-mail address. I guess my main would be pmccaffrey@tmc.edu

: Outstanding and will also include links here to Peter's link then anything on Twitter or anything else like that that you like for listeners to know about.

: I should have a twitter. I don't.

: I actually didn't have one. And as I was building the podcast Peter, I had a couple of friends notably Nick Adkins from the pink socks movement he's like oh you just need a Twitter account period.

: Yeah.

: That's a good share space.

: I have to make one.

: Yeah. No worries. So listeners Well again we'll include Peter's email and his linkedin. Feel free to connect with him. Just go to outcomesrocket.health/peterm and you're going to find all of that as well. Peter, this has been such a pleasure. Thank you so much for sharing your words of wisdom. And we're really excited to see how the company turns out.

: Wonderful. Thank you for having me. This has been wonderful. I appreciate it.

Thanks for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book and Podcast:

Dune

Cloudera

Best Way to Contact Peter:

pmccaffrey@tmc.edu

Linkedin  - Peter McCaffrey

Episode Sponsor:

Accessing The Highest Quality Care at the Intersection of Music, Technology and Neuroscience with Brian Harris, Co-Founder & CEO at MedRhythms, Inc.

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing health care thinkathon. That's outcomesrocket.health/conference.

: Welcome back once again to the outcomes rocket podcast, where we chat with today's most successful and inspiring health leaders. I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have an amazing collaborator in health. His name is Brian Harris. He's a co-founder and CEO at Medrhythms Incorporated. He's a passionate motivated leader and entrepreneur who strives to make the world a better place by helping others. He's demonstrated that these amazing qualities by building world class digital medicine companies and developing the arts and neuroscience group at the American Congress of Rehabilitation Medicine. His company Medrhythms focuses on digital medicine that uses sensors, music and artificial intelligence to build evidence based neurologic interventions to measure and improve walking. That's a mouthful right there but that's because Brian does a lot. And so what I want to do is open up the mic to him to fill in any of the gaps of the intro and we could kick off this podcast. Brian, welcome to the show.

: Well thanks for having me. It's certainly exciting for me and honor for me to be here so I appreciate that very much.

: Absolutely. So tell me Brian you've got a lot of interests. You've done a lot of really interesting things. Why did you decide to get into the medical sector?

: Yeah it's been a really exciting journey thus far. You know getting into health care and growing Medrhythms and it actually started you know when I was growing up I was a musician. Music was a passion of mine. Played a lot of bands a lot of different scenarios that way and I knew that music needed to be a part of my life long term more than just a hobby. But I knew that music education wasn't going to be for me. It just did. I didn't have a calling to it in the performance world I didn't have a calling to have either. And I learned about the idea of music therapy of using music to help people when I was in high school and I said you know this makes a lot of sense to me. But when I was in college I took an online class in music therapy I'm from the state of Maine took this class at the University of Maine and I had this opportunity one summer to intern with at the time the only private practicing music therapist in the state of Maine.

: How did you find them?

: So luckily he actually was the one that had been contracted to teach us on my class that I had taken and so I reached out to him and you know I had this opportunity and during that summer he was working with severely developmentally delayed children and adults and I had the opportunity the very first session that I ever observed of music therapy of an actual board certified music therapist who would work with an 18 year old boy who was functioning cognitively and physically at about a 1 year old level. So a very very low functioning boy and this music therapist began doing music with him and within the first 10 minutes in the presence of this music therapy session this boy was cognitively functioning at a higher level than what anybody had ever in his life. Wow. So I distinctly remember his family the people that work with him in his day program who came into the room and were literally in tear because they couldn't believe how this boy was functioning. And it was at that moment that I said A. that this is my calling in life and I need to you know devote my life to this and B. was while this was a magical and beautiful thing to witness this boy that there was a reason why he was having this response neurologically. Something was happening in his brain and that if we could answer that question of why that it then we could really harness that power of music and replicate it to help a lot of people. And so that's what got me focused in on music therapy and what was actually called neurologic music therapy so really explaining these things through purely neuroscience. So fast forward I became a board certified music therapist and with advanced training in the neuroscience of music and how that can be used to help people recover things like movement language and cognition following any sort of neuro disease or injury. And I actually started the program as a clinician as a hands on board certified music therapist operating much like a physical therapist or an occupational therapist a speech therapist would at Spaulding Rehab Hospital in Boston and what we were seeing particularly in gait training or improving walking after injury that people were getting better faster with greater results. And sometimes music was the only thing that worked. And we said to herself why doesn't everybody have access to this. And how do we bring this to more people. And at the same time the field of digital therapeutics and digital medicine was beginning and getting a lot of weirdness around that and it was really good timing and we became committed and said what digital medicine and digital therapeutics is the path forward to bring this intervention to everybody who needs it.

: Brian this is such a touching story and it definitely like when your passion hits you or your calling hits you, you know. And when you were in that room with that boy that 18 year old boy and that's when it grabbed you and you haven't looked back since. And it's really a really great story. Thank you for sharing that.

: Well yeah, thank you and I appreciate that. It is one of those moments. And you know I distinctly remember it happening and I you know honestly felt so fortunate to be sort of early on in a career and have one of these moments and I said this is really about something that's much bigger than you know right here in this room with this boy that the only way that we can go forward with this is figuring out how we bring this to more people. And to me that was always through something like neuroscience because that's what you know medicine appreciates that's really how we're going to move forward with this. And you know it has been one of those things where it's been very focused journey so far and we're trying to keep going without looking back into the future as well.

: That's awesome. And listeners, you know the power of music with healing. We had a guest, you guys probably listen but if you haven't. His name is Walter Warzoa. He's outcomesrocket.health/walter I don't know if you know Walter from Los Angeles from HealthTunes.

: I actually listen to the podcast I haven't met him before myself but I did listen to that.

: Oh you did. Cool I'll have to connect you guys because you guys are on the same wavelength.

: Yeah he's doing some very interesting stuff. I would love to be connected to him.

: Yeah. And so so you know no doubt listeners. Music is powerful and if we go back to the beginning ages just when humans first got on earth you know music moves people, music heals people and I love what you're doing Brian because it gets down to the science of it and it's just so powerful so. So tell me a little bit about Medrhythms and some specifics about how you guys are improving health outcomes.

: Yes, we have built a digital medicine platform that replicates one of our standardized interventions in neurologic music therapy that's called rhythmic auditory stimulation and essentially what that is is using rhythm to improve walking. So what the research actually shows is that from a neuroscience perspective at a high level is that when we listen to a rhythm in our environment that it activates the auditory system because it's inhibitory input but also because it's rhythmic that it automatically engages the motor system. Subconscious level and those things actually begin to fire at the same time. And that process of aligning the motor system and the auditory system is what we term entrainment your brain entrains to an external rhythm and that is something that happens in 97 percent of the human population regardless of age, culture, ability or disability. Everybody is brain neurologically responds the same to music in this way. And so what we see especially even in people that have damage to that motor system so something like Parkinson's disease or Huntington's disease or stroke that affects the way that they move we can actually use music or rhythm as an external cue to engage that damage motor system to help them move more appropriately. And what they've also shown is that when you exercise to music or when you move to music over time that it aids and that process of neuroplasticity of your brain's ability to heal or strengthen connections throughout your life. And so what we're doing is we are using a digital method platform we have sensors that connect to the shoe. They collect all of the data about walking so that symmetry strides like cadence x y the plane of your foot in real time. We feed that into our algorithm that's software based mobile phone and then we change music in real time guided by those neuroscience principles of how music can improve walking. And what we've been seeing it through the research that's been done on the intervention itself over the past couple of decades is that primarily in gait speed that we're able to improve gait speed by .3 to .4 meters per second. Over the course of therapy and what we know is that we look at other outcomes other than just for helping people to walk faster and safely. We also know that gait speed is also correlated to things like falls which is a huge burden to the healthcare system and also connected to things like annual medical costs. So while we are improving just you know mobility and helping people to be more independent through improving the way that they walk. We also see there's a really big value here and also potentially being able to prevent things like fall and decrease medical costs over time because we're keeping people healthier.

: Now that's super interesting. And Brian thank you for sharing that very fascinating way of getting to these improved outcomes and you've not always had a working solution. Can you share with the listeners a time when you had a setback or a failure and what you learned from it.

: Yeah you know that's a really great question and certainly you know in this journey of entrepreneurship there's often times where things don't go as planned and you know it's interesting. We actually started the company as a therapy company where we were hiring board certified music therapist to provide this care in person. What we quickly found and as we know as we started to grow it was primarily people paying out of pocket for this. But we quickly found that a scaling up services business takes a lot of capital takes a lot of time and there quite frankly aren't many people as you can imagine who are trained in this area.

: And there's a lot of variability too right.

: Oh certainly a lot of variability here as well even within the field of music therapy there's a lot of variability even in terms of how people are trained and where they practice and what their skill sets are. And we came to a turning point where it says what is the future of the company look like. Because this isn't accomplishing the objective that we've set out. And while we are helping a lot of people in the area we aren't making the impact that we wanted to make. And that's when we really had to make that decision that well the path forward is actually not necessarily just in services or in people providing this care but it's actually in technology and digital therapeutics to be able to do this and the field actually has advanced such and the technology that such a technology can do.

: That's interesting. And thank you for sharing that. And listeners, a thing that you'll notice other folks that we have on this podcast are the ones that have taken the courage to create and to build and it's not always easy and you always have to be managing two businesses. Number one the business that you're in. And number two the business that you're becoming. And Brian, thank you for sharing that because it's something that every entrepreneur goes through especially if you're going to be successful and so if you had to pull out a nugget from that learning what nugget would you share with the listeners?

: Well I would say you know one of the most important things about this process for me has really been be open to change. Being open to taking in the information that you have and being willing to make decisions and important decisions and commit to them. And so while we thought that we were going to be a services company going forward that's not who we are now and that's not who we're going to be into the future. And when you make a decision you really have to sort of go all in when you have to commit to it in order to be successful in that area.

: Very cool. Very cool. And part of what you guys are doing in this pivot Brian is is using artificial intelligence. Can you share with us how you're applying it?

: Yes. As you know by virtue we're still early early on in the development of our product. We're still working on building that out. But what we're looking at is all of the data that we're collecting about walking about gait and how people move we're getting real time data or real world data of how people are acting in this space. And so with that data what we're doing is we look at our ability to be able to A. make our algorithms better over time with the data that we're collecting and then B. potentially to be able to look at even prognosis or diagnostic capabilities to say well how is the disease progressing. And so looking at taking that data and saying well somebody who has Parkinson's disease that affects their movement we can actually see how the disease is progressing over time and using AI to unlock those features and also being able to potentially diagnose when somebody is at risk for fall racing and how their gait declining etc.. So we look at our AI to 1. make our algorithms better and 2. to potentially be able to unlock a predictive and diagnostic capability

: Super exciting man. I'm very curious on what's going to happen there man make sure that you reach out to me again when you get things going because I'd love to hear how things are improving outcomes with artificial intelligence.

: Yeah we certainly well you know we are as I said we're at the beginning stages of this. We've started to use this with potential clients and we've seen some really incredible outcomes so far that we get really excited about. So I look forward to seeing when we start to incorporate the AI going forward. You know how that even takes us to the next level.

: So Brian share with the listeners a time when you had an amazing success. One of the most proud leadership moments in medicine that you've experienced to date.

: That's a fantastic question. And you know I mean for me I'm a clinician by training and you know sort of a clinician turned entrepreneur and so the things that excite me about leadership in this space is really talking about how we are impacting the lives of those that we serve. And you know the reason that we exist as a company and the reason why obviously I think of most healthcare companies exist is because they want to help people improve. And there's one particular client that comes to mind that really was sort of the inspiration for Medrhythms and for metals as a company in terms of improving walking and also for us to build this device. It was a guy named George who had had three weeks of physical therapy. Five days a week at Spaulding and had been walking with a cane and he had just begun walking with a cane and was walking very slowly and he was unstable and we began doing this intervention called rhythmic auditory stimulation. It was me as a clinician and in one 45 minute session George was able to walk without a cane for the first time since his injury he walked twice the speed that he had walked at the beginning of the session and walks six times in the distance. Over one 45 minute session. Amazing. And for me that was the point where I said this is something that the world needs and the world deserves to have. And as we've been testing our device now to replicate that intervention that we were doing then actually just last week we were doing some product testing and we had a stroke survivor who came in who had her stroke 20 years ago. In 1997 she had a stroke and we actually did about 30 minute session with her every day Monday through Friday last week and she showed a 25 percent increase in her gait speed over one week from the beginning of Monday to the beginning of Friday. Her baseline speed had increased by 25 percent. And so these are landmark moments for me to say that A we can do that B it's working and C something to get excited about going in neutral.

: I love it. Brian there's no doubt that you keep the patient at the center of everything you do. And I think that is a very key part of your success to date and why you're going to continue to be very successful in this space moving forward.

: Well thank you. You know I think you as I said one of the things that we hope that all people in that are building companies is health care at the crux of it all is that it has to revolve about the patient it has to be about improving those outcomes. And while we need to certainly get the business right in order for us to be successful which is you know there's many challenges in and of itself that we focus on at the end of the day. People need to enjoy it. People need to use it and people need to show improvements. If we're going to be successful.

: Absolutely. So Brian this is the part of the podcast where we take a dive into a horse that we're going to build it's a syllabus for the listeners. It's the 101 course on how to be successful in medicine. The Brian Harris Crash Course. OK I got more questions for you lightning round style followed by a book and a podcast that you recommend to the listeners. You ready.

: All right.

: All right. What's the best way to improve health outcomes?

: Best way to improve outcomes is to be collaborative with all the providers payers customers in health care. You're bringing people together. That's the only way that we're gonna improve outcomes in healthcare for working together.

: What's the biggest mistake or pitfall to avoid?

: I would say in this area is trying to go it alone and being isolated and not you know taking feedback from other folks.

: How do you stay relevant as an organization despite constant change?

: Well I think we're number one as being true to who you are and listening to your customers and making sure that you're providing value to them. I will allow you to be sustainable over time.

: What's one area of focus that should drive everything in a health organization?

: I think we've hit on this a few times today but I think that it really needs to be centered around the patients and their outcomes and what value you can provide to them.

: What book and what podcast. Brian would you add to this syllabus.

: That's a good question. One of my favorite go to books actually that's not necessarily related to healthcare but to business in general is a book called The go giver and it's something that we have all of our employees read as well. And it's really a book about it's a play on the word go getter but the go getter is actually seems self-serving for the giver. It's about how much can we give and add value to other people and therefore value will be added to our own life. And it's a book about sales but it's really life lessons on how to be a go giver. And so I suggest that book and a podcast. I apologize all about this but I have to say I really appreciate what you're doing here in sort of being on the leading edge of bringing people together. I'd say people should go back and listen to all of your previous podcasts as well because you really crossed the domain in this space and bringing a lot of different points of view here. So I would certainly suggest people do that.

: Thanks brother I appreciate the plug and man The go giver. I love that.

: It's a phenomenal book. And you know I've read it a number of times and every time I read it it gives me a new perspective on how to be an effective leader and you know how to really make a difference in the world. I would certainly suggest checking that book out.

: Man that you spoke to me right there Brian because so every every year I choose a theme for my business or my life. And so my theme this year I chose two words and those two words are faith and giving. And that title just it was delivered to me by the universe through you my friend.

: Well you know I think that those are two important points in life. You know faith and giving are two things to be focused on so I'm happy to hear that. And you sent me a mailing address and I'll send you the book.

: You're the man. Brother I appreciate that. I will definitely do that. All right. Major major gem's here major words of wisdom by Brian. Don't worry about writing it down. Just go to outcomesrocket.health/HARRIS That's Brian's last name and you're going to be able to find it there. So Brian before we conclude this has been a ton of fun. I love if you could just share a closing thought with the listeners and then the best place where they can get in touch with you.

: Great. Yeah. You know I think for anybody that's listening out there I think that now is a really exciting time to be in this field of health care and to be innovating in health care because I think we're going to see a lot of exciting things going into the future and I think the more that we learn about technology from my perspective the more that we learn about music and how music affects the human condition that it will change the landscape of healthcare as we know it. And so that's what I get excited about and I hope that you get excited about those types of things too. And being innovative and being open to change and open to make a difference in the lives of those that we serve. If you're looking forward to getting in touch with me I welcome people to reach out. You know I'm always open for collaboration and having conversations about how we can tackle this problem in health care together. You can check out our Website now at www.medrhythmstherapy.com which actually is focus a bit on our therapy practice. But you know my email is bharris@medrhythmtherapy.com and I do hope you'll reach out.

: Brian this has been a ton of fun and listeners. Again you want to get all the information the links, Brian's web address, as well as the things that we talked about the links to the go giver and the show notes. Just go to outcomesrocket.health/Harris harris and you're going to find everything there. So Brian just want to say thank you so much. Really appreciate you taking the time to share your passion and your words of wisdom with us today.

: Likewise. Thanks so much for having me. It was really an honor to be here.

Thanks for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book and Podcast:

The Go-Giver

Outcomes Rocket

Best Way to Contact Brian:

bharris@medrhythmstherapy.com

Mentioned Link:

http://medrhythmstherapy.com/

Episode Sponsor:

Outcomes Rocket - Justin Barad

How this Orthopedic Surgeon turned Entrepreneur is Improving Outcomes with Virtual Reality with Justin Barad, Founder/CEO at Osso VR

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists to set the tone we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're gonna want to act soon. So how do you learn more. Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing health care thinkathon that's outcomesrocket.health/conference.

: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have an outstanding guest for you today. His name is Dr. Justin Barad. He is an orthopedic surgeon and founder and CEO at Osso VR. They're doing some pretty amazing things. His passion is medical technology. He's always been fascinated with ways that software and tech can be applied to help people and as a pediatric ortho surgeon. He's had an incredible way of just tackling some of the most challenging musculoskeletal issues facing our world's children. And he's got some technology to pave the way to do it as well. So I want to open up the microphone to Dr. Barad, Justin and have him round out that introduction. Justin welcome to the podcast.

: Thanks Saul, it's really awesome to be here your show is fantastic. And thanks for the very kind introduction.

: Absolutely. You're doing some pretty cool things Justin and I'm glad you're able to carve out some time in your busy schedule. I always like to go to the root and wanted to ask you why did you decide to get into medicine to begin with.

: Oh wow. I mean if you really go back there was a computer game called life and death. They didn't get me initially interested in medicine. Ironically it was sort of like a surgical simulation game. It was very primitive. I was really excited to be a doctor. This is I don't know in elementary school probably like sixth grade. Then I went to a hospital once with my cousin who was a surgeon and I got very freaked out and decided did not want to do that. And mentally I took that the other direction and decided I want to become a videogame developer. So while I have been coding my entire life and I worked at Activision walls in high school I have a game credit with them which I was very excited about. And as I was finishing up high school kind of medicine came back into my life a little bit. Family member started becoming ill was in and out of the hospital. She's fine now but it just made me realize that kind of what I wanted to do with my life. I wanted to have an impact and and maybe I saw a lot of challenges that she was facing that the healthcare system wasn't necessarily equipped to deal with. And I thought to myself I wondered if there was a way to use software and technology to help solve medical problems. So in college I studied bioengineering at UC Berkeley with the goal of being an engineer inventor type in inventing technology. So as I was nearing college graduation I was interviewing for a bunch of jobs but nothing seemed quite right. It was like you know you were going to be kind of on that conveyor belt and helping increase efficiency of medical device production. So a gastroenterologist who happened to be my mentor Dr. Henry Lee and I sat down with him and you know he saw that I was kind of not very happy and he's like well if you could do anything what do you want to be doing and I said I want to be inventing technology that helps people with medical issues. And he said well in order to invent something you need to know what the problem is and in the medical world the best way to find out what the problems are is to be on the front line as a physician. And so at first I said absolutely not. I don't want to spend that much time in training but you know eventually he convinced me. So I spent a year in his lab doing research and getting all the pre-requisite classes and then I got into UCLA for medical school and I end up graduating first in my class and then I stayed there to do orthopedic surgery.

: Very cool. Very cool. So it's just been this ebb and flow between medicine and programming video games. Kind a back and forth. And now you're in this sweet spot where you're combining both of your passions and interests.

: Yeah well I think we all have serpentine life and career journeys and when it kind of comes together in those Venn diagrams intersect that it can be a really special moment to know that everything you did sort of might have a purpose or a meaning. So it was during my training where I was experiencing what I thought was the most critical problem I've ever seen in medicine and that's how we train our surgeons. And I was seeing every day how it just was no longer working at the level we needed to. And I saw a lot of patients being put at risk while people were basically practicing on them instead of knowing what to do ahead of time. And I was still very involved in gaming on the side and make monster games and experiment with new technology. And one thing I was very passionate about very early was virtual reality when I had this sort of renaissance after a brief attempt in the 90s in the field Virtual Boy which I still think is a fantastic system I love it. And so I got involved in the very early and I was able to hack together an oculus DK one which was the original Kickstarter release with this discontinued motion controller your hands and what that allowed you to do is get your hands into the VR experience which was really hard to do back then and wasn't really an option. And the second I saw that I knew that I had found the solution for this problem. And initially I was like wow I can't wait for someone to use this to solve this problem and then I had this kind of slow realization I was like wait a second I have this background to gaming. Maybe that person is me. So that's kind of the the origin story of Osso VR. You know I started working on it on the site and building a prototype and then eventually met my co-founder who had quit professional gaming to pursue serious VR in October 2016. We both worked full time with the endeavor.

: That's awesome man and listeners. You could hear the passion in Justin's voice. And now if you go to ossovr.com. You're going to see what they're up to. You'll find a link of that in the show notes as well as well as the other things that we're going to touch on today. But super interesting capturing the essence of virtual reality and helping train both surgeons and also companies sales reps in these procedures. Can you tell us a little bit about what you think Justin should be a hot topic on every health leaders agenda.

: Well I think training should be at the forefront of everybody's agenda as you say on. It is we're in the midst of a training crisis and I think very few people realize this when you just look at some of the numbers. It's very concerning. So to understand the surgical training process you know what you're expected to do as a surgeon is you go to college is about four years typically in med school which is another four years. That's 8. And then you have about five to seven years of residency. So then you're looking at 13 or 15 on top of that and then typically another one to two years of fellowship. So a massive investment of time and money.

: Logn road.

: And a study came out in 2017 looking at the ability of graduating surgeons to operate independently. So you would expect that the end of all that someone should be able to do the job they were trained to do. And as of 2017 for the most common procedures 30 percent of graduating surgeons were unable to operate independent.

: That's a big number. Yeah and it did talk about why.

: Yeah there are a lot of factors going on. It's a phenomenon we're calling sort of generally calling the training gap and it's really pretty simple math. At the base of it in that the number of procedures we need to learn is always getting larger. Think about it. There's new technology new approaches new techniques constantly new things that you need to learn. And in general newer techniques like minimally invasive techniques navigation technologies patient specific devices robotic surgery these are generally more complex and harder to learn than traditional open surgery. And compounding this problem is the time we have to train. So it's actually becoming much less a few years ago. There were what were called work hour restrictions imposed on residents.

: I remember when that happened they kept it at 80 hours or something.

: Yes it's kind of hilarious because people views it as very weak for only being able to work 80 hours a week. But it's still quite a large number. But when you look at the difference between how many hours people were hands on with patients before and how many now that actually factors into about a year of training time. So it did have a big impact even though it's the right thing to do because people were getting in car accidents on the way home post call was really terrible situation.

: Yeah.

: And then technology in a way is further affecting the issue because electronic medical records systems now take up a lot of our time. And so basically the people who are training us want nothing to do with the system so it's typically up to the residents and fellows to be entering all the data and coding the counters. And research has shown that up to 50 percent of our time in the hospital can be spent on a computer on an electronic medical record systems and not in front of patients. So that's another big factor.

: It is yeah, that so bad. And I don't know what the answer to that is just and to be able to decrease the amount of time that spent on those things. I have a friend that started a software company and it basically is designed to make EMR easier and automate repetitive inputs and we need more more stuff like that. But anyway to get back on track here definitely a big problem. And so that also takes away from training hours.

: Exactly. And then I guess the final factor is sort of a shift in kind of the culture of what residents can or are expected to do and some of this is sort of a societal thing where we as a society are now more aware of residents and surgical trainees and very specifically say we would not like them touching us which is understandable but who are they going to touch and practice on and also focus on sort of efficiency and productivity of the operating room and also liability issues. So you know when you're a surgeon and this patient is trusting you to get the very best care it's hard to let someone you know is less skilled than you actually do parts of the procedure. And so it's a bit of an ethical conundrum. So all of this combines to this dynamic which is very worrisome which is further worsened by the fact that there's data showing that by 2050 we're going to be about 50000 surgeons short because we have an aging population. We have a relatively decreasing workforce because we have this sort of like Demmink aging demographic that's flipping in terms of the peer man and it's leading to what's going to be a very challenging dynamic where this population needs a disproportionate amount of procedures that kind of this relatively limited younger population cannot provide which isn't helped at all by the fact that the vast majority of residency spots in the U.S. are subsidized by Medicare. And so the number of residents we can train is also fixed by the government. So a lot of challenges and really very little being done about it at the moment. And so you know I view a lot of what my job is not only in terms of providing a solution but sounding the alarm and educating people about the issue both in the medical and outside the medical world. I think we all as a society want people who are highly trained to be taking care of us and our greatest times of need.

: Yeah that's that you bring up some really great points highlighted some big issues that we have in the system and let's zoom into Osso VR and and Justin. Can you share a time or an example of how your organization has improved outcomes.

: Yeah. You know I didn't leave full time surgical practice to kind of make a buck. I really want to solve this problem and so very early I wanted us to make sure that what we were developing actually worked and wasn't just a cool marketing gimmick. So we did a small pilot study at UCLA and we took a group of medical students and half of them were assigned to VR training and then half were assigned to traditional training which was like a lecture textbook and some illustrations and things like that. Then we had them all individually go through and do we call it sawbones which people tell me sounds hilarious but it's kind of like the closest you can get to actually operating on a patient. We had them all do a sawbones procedure and the blinded observer rated their performance. What we found at the end of that was that the VR trained individuals performed nearly double as well as the non VR individuals. So we have a lot more studies coming out of UCLA that we're designing right now. And ultimately it's very challenging but we want to tie use of our platform with how patients do in terms of complication rate length of OR readmission and things like that because ultimately you really want to show that this is directly affecting patients and their outcomes. But there is no doubt that the level of skill transfer you get just from a few minutes in VR is exponential compared to traditional means. So why would you want to know some of the surgeries that I participate in. We're like 12 to 15 hours long. Why would you spend an entire day when you can learn exponentially more by doing yourself in just a few minutes as opposed to just standing around and watching. Which is what you do for the vast majority of these like five to 10 years of your postgraduate training.

: Yeah that's a really good point fifty percent betters a big number and just thinking through all the things that could happen by way of variation there's variation in the way that things are taught. There could be a more standardized and streamlined way to spread the training as well. Right.

: You touched on one of the key issues in the surgical world that everyone just does whatever they feel is best for the patient and there is zero standardization. And so if there is a way that we can all agree as sort of a professional group that here is the way that we want people to do this procedure it unlocks a lot of potential in that now you can actually measure how well that is working and make changes on a mass scale as opposed to just letting everyone do their own thing and hope that it works out well.

: Yeah that's really interesting. And you know what I think would be really interesting to Justin if they took this product and you went to the board of you know orthopedic surgeons and and they incorporated it as part of becoming board certified.

: That is exactly what we are attempting to do.

: Is that right. Because I mean that right there is I think cementing it into the process. And they've been pretty receptive.

: Everyone I show this to as you know knows that this is something that is not a nice to have but a need to have and that we're at sort of a crossroads and we really need to make investment in this area in order to solve a lot of the problems we've been discussing and that's why we were able to you know assemble an advisory board of just unbelievable people like the former chair of surgery at Stanford in the presence of a very large professional societies so we're really working you know not only to solve the problem on a technological level but also on sort of a regulatory and professional society and standard setting to agree on what do we want people to learn by the end of their residency so that you kind of know what you're getting at the end of this machine to give you an example of why that's not happening right now. Residency is really an apprenticeship training model so you're just kind of following people around and just seeing whatever they walks in the door that day. So what happens is that just based on statistics you get a lead variable experience. For example one of my co residents was doing a hand surgery rotation and one of the most common procedures we do is a Distel radius fracture it's a wrist fracture Mitz trauma. So it only happens when someone trips or the skateboard or accident and in his two months that he was doing this rotation where he's supposed to see a lot of these you actually saw zero because they just never came in. Then he moved on to a different rotation and he just was never going to get that experience because of random chance.

: Interesting yeah that's so true the trauma right if you focus on those particular things how can you augment it, it's a good solution.

: Yes. So in Brian George's paper from 2017 which I mentioned earlier about residents not being ready to practice. He sees this as a vicious cycle. So what's happening is that surgeons are graduating they're not yet able to practice on their own so they're still learning. And so now they're in practice with residents of their own. They're expected to teach but instead of teaching residents they're focusing on their own learning and then.

: Right.

: The cycle continues and worsens and so he thinks that one of the main ways to break this and create what's called a virtuous cycle is through simulation which you've been seeing in aviation for decades be very effective in terms of you have a standardized curriculum that everybody needs to know so that their skill level is kind of a proficiency where they can perform the most common procedures safely and also have a launch pad to when they do get in front of patients. They're starting from a more advanced level so they can get more out of their rotations. So in a worst case scenario like my co-resident at least he would have been proficient in the simulator. So he knew that it was safe for him to do that surgery out in the field as opposed to starting from zero which is what's happening right now

: Totally yup and I'm just like envisioning it being part of you know hey you're trying to get a fellowship here. Well can you show us your Osso score.

: Oh my God. You bring up one of the most incredible issues. I mean I think would blow anybody's mind if they ever just looked into this. So I mean I would ask the audience like how much assessment of actual technical or surgical skill happens when someone is admitted into residency.

: Yeah I mean I don't know what the answer is what is it.

: It's zero. So typically it's just you know if you have good grades and you seemed like a nice person you won't mind being up with at 3:00 in the morning when neither of you have slept your end. And then at that point it's almost impossible to get kicked out of the system like you could be a terrible surgeon but unless you're actively murdering people which I assume it's just you're going to get all the way through. And so there's some people aren't be Olympic athletes or some people that can't be pilots much like surgeons but these people just just get through and then you know they're taking care of patients. And should they be are. And also you know this is an issue just down the road like what if you just can't let yourself go and you're just not really trying anymore. Don't we want our surgeons to be of a certain quality level as a society and there's just no one checking that are looking into that right now and you just can't just coast through. It's pretty crazy to me actually.

: Now it's really interesting Justin and I think the direction that you guys are headed is definitely one that will potentially create as Standard a certification an index so to speak.

: Exactly I think people right now you know when I'm going to see a physician or one of my family members they're really going on to things like availability and affability and the least important you know people say is ability but when you think about it there's no way to really know that. Like what are you basing that off. It's like what patients did well. Well actually most people do do well. The complication rate between like a really poor surgeon and a really good surgeon is a few percentage points so it may be hard for you to differentiate that you're not going to get that out of Yelp reviews or anything like that. So I don't think it's it is a little unfair to patients that they're not able to get some high level kind of indication of truly how deft is this surgeon how shaky are his hands right. Aren't these things that people want to know.

: Oh totally. Yeah. So it sounds like things are going well. Justin can you share with the listeners a time when he made a mistake or had a set back and what you learned from that.

: Oh wow. So so many I would say you really want to hiring I think is the biggest challenge when you're starting a new company in a new endeavor. And the tendency is to want to just build the team build the empire and just when someone comes along maybe you're having trouble attracting technical talent and you just need somebody. But I would caution people that I think team trumps talent really and there is like a fit and you want to. In the early days it's just so crazy that you need people that you're going to be able to be honest with work well you know practice radical honesty as they say. And just stay focus with ruthless prioritization and the concept of like too many cooks in the kitchen or just throwing more people at it doesn't necessarily lead to more productivity or a better solution. So you know stay lean iterate quickly and really just I would say that the biggest word for us has been focus. You're doing something no one has ever done before. You can go in any direction you want. And so I think the tendency is to try and go in every direction sort of spray and pay or spaghetti against the wall and just see what sticks. And there is some of that that has to happen. But if you have focus on a vision and really stay mission driven and so like have a North Star or like what does everybody working towards. I think that has gotten us through I would say ninety nine percent of our challenges. Whenever we have an issue with the technology customer just internally with our team we always remind ourselves why we're doing this and what we're trying to do and we're able to find a solution and get through it and just you know being very careful that everyone we bring on feels that same way.

: That's a great share. And listeners it's all about the team you build and the focus in your why and the direction and Justin and his team definitely have a clear north star and they're doing some really interesting things. So as far as I understand it Justin you guys are are looking beyond orthopedics you're looking into cardiac procedures isn't that right.

: Yeah. We're exploring the robotics and interventional cardiology space as well and we're really focused on areas where the complexity and the technology have gotten to the point where they exceed our ability to learn it in a reasonable period of time. So you know a lot of robotic technologies or some of these new structural heart procedures you may have to perform 50 to 100 times before you can do it safely and with the tools we have available today that's mainly happening on patients. And so in something like the world of Cardiology I mean that's potentially fatal event but oftentimes what happens is a surgeon or procedure list will try a new technology which is amazing for patients and they want and are typically higher value and have a bad experience very early on and they'll feel burned by that. And in the industry they call it a one and done phenomenon. So what happens if a surgeon feels that the device is unsafe and not realize that they were just undertrained and they'll stick with older technology which is probably not as good for patients. And so what we're trying to do. You know one of our mission statement is increasing patient outcomes through the adoption of higher value medical devices and techniques and also democratizing access to modern surgical education around the world which is something you can do with our technology.

: I think that last piece is really interesting too because there's countries around the world that don't get the opportunities a lot of people that want medical training come to the U.S. because there's a lot of great training here. And this is a way that people could actually get the training without even coming.

: Exactly. It's VR has the power of what we say teleportation and capturing expertise and distributing it. And so even you know you have people from other you know very well regarded countries coming here to learn how we do things. But there is the world like where I go on medical missions where they don't have the opportunity to travel anywhere or really get much training where they are and things that are very easily treated here like a lot of trauma that young people experience over there often goes untreated or mistreated and it's a huge burden for their economy because they've taken a very young productive member of the economy and is no longer able to work because of sometimes a very minor injury. So this technology has the potential for really massive global impact in a way that I'm really excited to see and we're really committed to that global mission.

: That's awesome just and very inspiring when you guys are doing and it's more than just here at home. What would you say one of your proudest medical leadership moments that you've had to date.

: Wow I still think just running a team and taking care of patients is something that I'm immensely proud of and I still think is the most special opportunity and it's a real privilege to have someone in their time of need to depend on you and not only that but you'll be able to deliver for them and to see people who are in horrific accidents walk again again are born with certain deformities and suddenly you know their legs are straight and they're walking around. I remember there there was one patient when I was a resident. And he clubfoot is a very common congenital deformity that is present at birth and it's treatable with just some casting and a very minor procedure and usually doesn't cause much issues throughout life but it's untreated. You're basically walking on your ankles and it's very very deforming and debilitating. So the 16 year old from Liberia came to Shriners Hospital was working at. We were able to do this in what's called a salvage surgery where we kind of cut out a bunch of bones from his ankle and fuse it together. It's not ideal but you don't have a lot of options at that age. He's coming back in for a follow up and I was walking by him and I heard him say like. He's like dad dad that's the guy who made it so I could walk again and I cry like every time I think about that. And that was a moment like that that I knew that I was doing something that I really want to dedicate my life to.

: And that the powerful just and you know just being able to touch patients in that way is a really powerful thing. Thank you for sharing a great story. Justin let's pretend you and I are building a medical leadership course and what it takes to be successful in medicine. It's the 1 0 1 course with Dr. Justin Iran. And so we've got four questions lightning round style followed by a book and a podcast that you recommend to the listeners. Ready.

: Very ready.

: All right. What's the best way to improve health outcomes.

: I think the best way to improve health outcomes is through training I might be little biased and also assessment. So we have one part of the puzzle which needs a lot of improvement but we have none of the other we need to know how are practitioners doing technically so we can know what can they what should they and shouldn't be doing and give patients access to this data as well. And I think that's really what's going to take us to the next level in terms of outcome. And it's just a data set. Nobody's looking at right now.

: Awesome. What's the biggest mistake or pitfall to avoid.

: I think I see this all the time but I find problems and not solutions taking a solution from the tech world or an idea you have in trying to find an application within medicine is almost always going to be the failure. It really takes a deep deep understanding of a problem and the various stakeholders involved the regulatory and reimbursement pathways the path the commercialization the competitive landscape a level of capital required all of these things are very important but they all stem from a problem and not necessarily the solution that you're thinking of. And so it really really really encourage people within medicine to just record problems and not necessarily ideas for like cool widgets. And if you're outside of medicine I really encourage you to get inside somehow so shadow a surgeon holism some around and clinic volunteer just get in there get on the front lines. That's what I did and it works wonders and every corner you're going to face some sort of challenge some sort of pitfall. And the answer is not going to come from some new technological development is going to come from understanding of the problem and how to approach that problem from a slightly different angle or how to approach a different stakeholder that you have deep understanding of so practice need based innovation find problems avoid the solution rabbit hole.

: That's a great call out. Justin how do you avoid eroding your impact. Despite all the constant change.

: I think just stay involved and build your network. It's really easy. If you're within medicine to just be siloed and just do it you do clock in and clock out and this bit which the world is moving now. You're going to miss everything fly by you and suddenly what you do might not really be as effective or irrelevant anymore. And so it's really important to stay connected to the world and whether that's technology or policy or somehow do something outside of the day to day of medicine. And similarly if you're interested in the medical world like I said stay involved and keep one foot in there so you can understand what are the shifting dynamics. What are the politics. What are patients saying it just going to make all of the difference and make you be able look one to two steps ahead. I always think about cardiothoracic surgery and how they were approached with interventional technologies and catheters and they felt that they didn't need it because what they did was fine. What they didn't understand is that their patients needed it. A cardiologist jumped at the opportunity and now cardiothoracic surgery is kind of a shadow of its former self. And you know cardiology is a booming field and so it's stories like that that remind me that it's really important to stay connected to your patients in the world of technology.

: Beautiful what would you say one focus area that every health organization needs to keep in mind.

: I would say to have more of a focus on fostering innovation. And I don't mean like starting an innovation group but truly from soup to nuts training your workforce and your physicians to understand innovation and how to interface with the world of startups and large companies and outside of medicine and not just function within your silo once again. And I say this because I feel that innovation is really a lifelong discipline and it's not something you can learn in boot camp or you know a few months at a seminar. And I think there really just needs to be a culture of innovation and it should be encouraged. And there should be policies that reflect that in order for an institution to really stay ahead of the curve and you know make sure that it's kind of like this was born here we did this. We contributed to this world because surely a rising tide lifts all boats and you're seeing this in the tech world all the time. It was really I had moderated a panel with a CMO of Samsung. And you know the medical director from Qualcomm was sitting right next to him and they both said that our companies sometimes don't work together but we need are technologies to interface with each other in order for us both to be successful. So I feel like right now this message hasn't really gotten across the medical world and you could certainly see it in the way that the EMR situation has manifested itself with the lack of interoperability. But the key is that if everything works together you get synergy an exponential increase in outcomes. And if everyone is just doing their own thing you're getting just additive kind of like baby steps. And that's not enough anymore with the rate of change in terms of the needs of the population and the exploding health care costs.

: That's a great call. Justin and what book and what podcast would you recommend.

: In terms of books I would recommend Doctors: The Biography of medicine if you are interested in medicine and startups in any way you will find this to be a very inspiring book because it is the physicians who made huge leaps for our profession and for our society in terms of the health care they receive but also the stories behind them. Who were they as people and why did they take these huge leaps or dedicate these lives to what everyone else thought was crazy like a Andreas Vesalius who at the time Galen had determined that we had discovered all there is to know about medicine. And there was nothing else to know. And people believed him and no one ever questioned this for a thousand years and then Basileus from Pat came out and he realized that Yalan had never even dissected a human cadaver before he'd only done animals and that was very taboo at the time so in secret he started dissecting human cadavers actually realized that there were many many inaccuracies and basically overturned a thousand years of medical knowledge by him kind of being the original medical disruptor or rebel. And there are many many more stories in the book and I find it very inspiring because these people who are like the heroes of our profession there are just people and they had the same kind of problems that we do and it's very relatable and gives you the idea that you do have the potential to solve these problems. Any one of us can do it. It just takes you deciding that I am going to do this. I'm going to stand up. I'm not going to wait for someone to tell me that I can or can't help to solve this problem.

: Love it. What a great recommendation and what podcast would you recommend.

: In terms of podcasts. I'm going to go nonmedical here there's this podcast called Song Exploder. I think it's just totally fascinating. It goes over his songs and basically breaks out each individual track and you can see how it all interfaces together. It's really interesting to see how these individual tunes that sound totally weird in isolation went together create a really incredible song. Kind of reminds me of medicine and surgery a little bit and I also love music so I highly recommend it when it's really cool and different.

: Yeah you know. That's on my ass subscribed list as well. Justin and listeners it is a very interesting podcast. Definitely check it out. Don't worry about writing anything down. Just go to outcomesrocket.health/barad Thats that's Justin's last name. B A R A D. You can find all of our show notes as well as links to Osso VR and all the things that we've discussed above the podcast. All these things just and this has been incredibly fun. All good things have to end as well. So here before we conclude I'd love if you could just share a closing thought and then the best place where the listeners can get a hold of you or get in touch with you.

: I would just encourage everybody listening to this. Just I always say it's okay to quit but never give up. I think the world is so exciting and you don't know what is in store and the next step in your pathway. And so I always say just have a bias for action just constantly move forward. You never know when a random Stanton game development is suddenly going to become relevant later on or if the path you're taking is the right one. Just don't worry about that just keep walking down it.

: It's a great message and what would you say the best place if somebody is interested in Osso or just collaborating with you guys how to get in touch.

: Yeah you can email me justin@ossovr.com or you can check out our website. There there's a contact form there www.ossovr.com. We have a big initiative this year to partner with healthcare institutions all over the world and also medical device manufacturers to help get their technology out there.

: Beautiful Justin. This has been a ton of fun. I definitely know that the ideas you shared are going to help people improve outcomes and I thank you for that and hope to stay in touch.

: Likewise. It was a total pleasure

Thanks for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book and Podcast:

Doctors: The Biography of Medicine

http://songexploder.net/

Best Way to Contact Justin:

justin@ossovr.com 

Mentioned Link:

http://ossovr.com/

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