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Looking up Home Remedies Has Never Been Easier with Serena Oppenheim, Founder at Good Zing

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have an outstanding guest for you. Her name is Serena Oppenheim. She's the founder and Good Zing. She's the CEO there as well and what they do. Good Zhing is that there are tech enabled platform democratizing health information. Good Zing gives users access to a greater degree of self care while improving health literacy. The expert and user generated content. The platform brings the world of health and wellness together. Now this topic of wellness continues to come up in the discussions that we have with our guests and in the general health care conversations out there. So this is a podcast that you're going to want to tune into Serena at Good zing won the 2016 business of wellness pitch contest and was voted people choice before it launched in 2017 spring. She's been featured in The Evening Standard the Huffington Post and Virgin. So thought further ado. It's true pleasure to welcome you on the podcast Serena.

Thank you so much for having me. Absolutely. Now did I leave anything out in the intro that you want to share with the listeners.

Not really when it comes to good zing. I'm sort of more I guess from a personal background which is unlike most people who come into the house space. You know I haven't come in as a doctor haven't come. And not from the medical angle I've come in because I know what it's like to lose your health. And you know what you've got into the house gone. So my personal background is that in 2005 when I graduated from college in the U.S. I partied a bit too much and I ended up with viral meningitis which developed into chronic fatigue syndrome and fibromyalgia both serious issues but not sort of have any medical not something that a drug can cure. Not something that is life threatening but is life altering. And so when I started this business which is largely by accident is I realized that I'm totally obsessed with the health space because this is what actually has a huge impact on people's lives. Yes there's some great businesses in hotels or in food or in shopping but actually without health you're nothing. So that's why I'm so passionate about this industry and it's great that people like you are doing podcasts like that it's bringing communities together.

Serena, what a great call out and listeners you're healthy. Most likely you're listening to this and you're healthy and maybe you're taking for granted that health and Serena's message here is strong right. I mean without that health wealth is insignificant. It's a basis that we all need to continue building on and keeping strong. It's clear why you got into the business Serena. What about a hot topic that you feel that needs to be on every medical leaders agenda today and how are you guys at Good Zing addressing it?

So I'm pretty much obsessed about this one plan is improving health literacy because if we don't have strong health literacy than all the other things we're doing around it just don't like strong health literacy to have the positive housing health outcomes. So I was doing some research around this a couple of months ago. And I read this report which said that only 12 percent of Americans and I know the figure is roughly similar. And U.K. and central Europe as well can be expected to fully understand the health and the implications. So whether that comes down to navigating health systems understanding what the doctors are telling them understanding what they should eat what they should do is it turns out the top many wonderful things in school and an education but in the way that actually gives people people on Sunday and health literacy were not taught that. And so if my one big bug is that every medical leader and everyone in the house should actually be thinking how do we improve everyone. We're not just talking about the elite and we're not just talking about the poor but everyone's health literacy. So they can actually take a stronger directive to the cost of the road in health. A stronger understanding that you know if they are sick and they get told to take pills why they have to take those pills at that time why they have to eat before that pill why they have to exercise. Because just for my own health experience when a doctor says to me you should exercise more and I guess what they all say. But actually why more impact does it actually have. And it all comes down to health literacy and I'm sorry I'm totally obsessed with the Zarya now.

You know what. It's great to be obsessed with this area and for the providers listening for the med device companies really, pharma companies everybody listening this health literacy is a serious thing. We as healthcare leaders suffer from the curse of knowledge and the curse of knowledge is that we know the topics inside and out. We're at a level 10 and companies like Serena's help us touch our end user our patient our customer at level 2 which is really where we need to be and so many of us are missing the mark. So I'm excited to really dive into some of these things that Serena speaks to us about in particular Serena, I love to hear about an example that you and your company have done to improve outcomes by doing things differently in literacy.

What before I even get to that point I should point out that I'm definitely not at level 10 I'm. So you know I was I did not do well in science at school. My concept basic biology is very low. So what I'm building Good Zing and when we're looking at the platform when we're editing articles that the doctors have written or editing articles that nutritionist writing looking at health tips we always say bring it back to layman's terms that someone says you should eat fiber. Really. I'm pretty educated person. But this isn't my area of expertise. What the hell do they mean by fiber? How much should I be having sup for munch? Should I not? It's breaking it down idiot proof and it's the same in any industry. So I used to work in renewable energy. I remember my first couple of weeks working the space at home with the road jogging to me and you slowly get it. But the bomb in the health space is there a Sermanni job. There's so much jargon. And there's sort of a wonderful thing that doctors are gods because they save our lives which is like the doctors that have saved my life I've had nine operations I've had a whole bunch of other issues that I haven't mentioned I freakin love all my doctors. But at the same time the ones that have had most impact, the ones I've broken it down for me. So I've actually understood what's going on in my own body without having the fear that I'm too stupid to get it or that they know everything when actually you know your own body but going back to your question I guess it's the biggest thing that is when people come to us and say they found a tip on the zing that helped. So there's one story that always makes me smile which is so occasionally we get sort of messages, e-mails, via social media people saying and they found tips that worked. There's one story I've really loved because it was a mother of three young kids based in Amsterdam and she emailed us to say that her 2 or 3 year old daughter had really really bad x mind seen lots of different doctors and a kid had been put on very strong medicines for it.I think it was steroids and she wrote say that she got good zing found a whole bunch different eczema related remedies from the bats and had gone to the doctor and said Hey can I try some of these. And she started putting her kid and a box or something and I turned around and home remedy. Now the kids Eczema is actually dramatically improved. And she had taken some of the nutrition steps and the kid is not actually on drugs anymore for the eczema and they have it under control. I quite frankly thought only happened to one person I believe. OK. We fulfilled it, that the mission of the company. But the fact is that it's happening a lot more. But what's quite interesting is when we started this it was only for common ailments so things like eczema or insomnia and would put up things like fibromyalgia chronic fatigue syndrome because I had those and I knew how hard it was to find that health contents without sort of being a blog space where people were ranting and raving about how terrible they felt. Know I will not call solutions not was the point. But then actually a friend came to me and said I think you should put mental health up there. It was a couple of years ago when we were still in beta still an idea was before mental health become trendy. And that is the area that we're seeing the most results because mental health is still something that people are how to go around saying they've got eczema they don't have it around so they've got embarrassing things like constipation. But it's most of the day to day issues that when it comes to mental health people in the UK and I know from my experience in the U.S. they're not that happy to talk about the fact that they are struggling with panic attacks or anxiety being vulnerable is very hard in our western society. What we're saying is people coming to us saying that they found a great meditation on good zing or they found a psychiatrist talking about why you should see a psychiatrist they've started saying one it has really helped them. So the whole point is that one heals differently. And what we're saying is that people are using good zing very differently to find tips that help. And that makes me very happy.

That's pretty cool. Folks, if you go to goodzing.com you're going to see they have a very easy to navigate site. You can search topics from a to z.

I'm going to push back on that and I apologize if anyone is looking at good zing. It's like one of our biggest screw ups.

I don't think it's bad will cause I think it's pretty straightforward but hey you know we're our own worst critics.

We're an anti bootstraps starters we didn't take a... because if we did a couple of big VCs in New York said they light up. They were and they wanted us to charge people for access to the well-being tips which went against every core belief of why we're starting this which was giving access to people who didn't always have it. So we decided just to bootstrap it. And it's been a great decision on some reasons. But we are currently working on fixing our UXO. Hopefully in the next two months.

Well folks I'll tell you it's not that bad. You go to the website. goodzing.com whatever it is that you're feeling right maybe you have a sore tooth today or a migraine or an ear or whatever you go there you find it and you click on it you click on to take for instance and similar to a blog page where you have all the blog posts on it. You have solutions that pop up for that particular one kind of cool and definitely beats googling and getting a bunch of ads and random things try. Good zing next time. Definitely a fascinating platform to find those solutions to the things that may pop up for you or your kids. Very nice. Very nicely done Serena.

Thank you. The big thing is also that it's user generated so let's say someone out there you have a great tit for eczema just because we were on that topic that your grandmother will buy or that your nurse told you about. Put it and the system is the whole point is user generated content because we all have these great tips on our own hands. Think about all the times you've been sitting around having lunch with friends or at a brunch and someone says I've got a sore throat. You know I can't tell time to be sick. Someone will always come up with a solution. That's the whole thing about it is like let's bring all these solutions into one place and set them all rated and reviewed with all these experts from different backgrounds. Also putting in that helps. So ultimately let's have a top ten list and that's the aim of that.

Love it. Serena you guys are doing a great job. Can you share time with the listeners when you had a setback or something didn't go well besides your UX of course.

Yeah. So we've made so many mistakes on the way

What did you learn from it?

What do we learn from it as is many. But it's basically as an entrepreneur it's about resilience. It's about philosophy and just getting back up. A year ago we sent out an e-mail that wasn't necessarily the quality that should have been. We got on a bit of negative attention from some UK lawyers and it was actually great because it made us take a step back and think actually we've got to be ten times more responsible than we thought this is. This is how content this has health information and lot of incredibly vulnerable young people out there that any knowledge of health or any knowledge of everything is via Google. So we sort of looked around in different ways we could be about content that we came across something good the well-spoken mark which is in the UK and in the U.S. And basically they're looking at is wellbeing contents and wellness content which as we all know you know you only have to flick through Instagram and you have a young beautiful blogger doing an amazing yoga pose on the beach who's giving a whole bunch of health advice but it's probably not qualified to do so. So what we've watched with this company whilst Berrigan is to ensure that our platform is as keen and who's responsible as possible so all these people are well-spoken man of all work in pharma or health and we've just been clearing things up so it certain topics that were not really going into anymore. We're checking absolutely every expert certification. No tip goes live on the site without our approval. You know we're doing all these things just to be as responsible as possible but you know we should have done that from day one but it was a mistake and we've learned from that and we've actually improved the product as a result.

That's awesome and the important thing is that you get out there start something and iterate as you go forward.

Yes and as every startup founder knows no matter what space it is you're constantly learning and you constantly iterating because you think you know what you're building. But actually once people start touching feeling that product, it's a whole different kettle of fish.

Absolutely. And this message has come up a lot listeners. So hopefully you're taking note don't build it fully and expect them to come. You've got to build it somewhat get some feedback and keep iterating. Just like Serena and her team have. Serena, what would you say when are your proudest medical leadership experiences to date is?

You see, I would never put myself in the word medical costs for me medical is all the wonderful doctors, it's the wonderful nurses it's the wonderful people who run the hospitals and run sort of what you do you know within sort of medical devices. For me it's more about wellbeing but I would say one of the proudest things is sort of reaching personal milestones so when we launched in May last year May 2017 you know we had a feeling of where we wanted to be a year later in terms of numbers unique to the site and we blew through the roof in five months and then we blew through the roof of our second year goal and actually at the end of year one says the proud moment is reaching those and knowing that we're reaching so many consumers. But the other aspect is this very proud to see people in the medical community starting to reach out to us speaking at different conferences. Basically the medical community. What makes me proud is when they realize that actually sometimes people like me who were the patient were the consumers that were coming at it from a different angle and that we are generally trying to help people when not trying to innovate in a way to get rid of them we're just trying to be there to help people and sort of when names that I really really respect in the industry have given us the OK that they've liked tarsal they've invited us to speak. That's when I get very proud. But I'll be a proud when 100 million people every month coming to this and finding all that solutions. That's what I'll be proud.

That's awesome. You've done a lot and a lot more to go. What would you say right now is an exciting project or focus that you guys are working on?

Something quite excited about. So at the moment we've got four categories: habits, emotions, beauty, and common elements which is the one we Sonson off that. what we're beginning to look at now is what are the other categories we should be looking at. So obviously pregnancy and baby two of the biggest ones but there's so many different topics were that. And so we're starting to look at how we can roll that out in the coming year but with that we've got to find a whole lot more experts say you know we're puting for midwives, nurses, pediatricians, doctors we want a lot more mothers as users on the platform so that they can share their experience as you know from babies, teething or what to do when yout ankles are swollen when you're pregnant. So all those kind of topics and sort of continually adding more content to the platform. That's what I'm excited about.

That is exciting and if you had that category you know I've got a 16 month old I know my wife and I would have been on your good zing constantly. There's always something new.

That we realize. But you know that's a mistake. You know I didn't have kids. And so when I started this I was like well these are the issues I struggle with. My friend came to me saying mental health. And you know so I went with the ones when you brought in a product you go with what you know and that now a lot more of my friends have kids you know my sisters have lots of beautiful children. So now I'm realizing that actually it's the pregnancy and baby category which you know so many people are struggling, struggling with confidence and we used to raise children in a village. So there were always different people you could talk to.

Right.

Now we're all living away from our families and it's a small family units. So who do you turn to for sort of what to do for your kids teething when you find that doesn't work but there might be another roots. So yeah that's our next big project which is terrifying.

I love it now. It's super exciting as well. Terrifying and exciting and I know you guys will do well. Serena getting to the end of this here. Let's pretend you and I are building a course on wellness and what it takes to be successful in health. It's the 101 Serena. So we're going to write a syllabus four questions that I'll ask you. Lightning round style followed by a book that you recommend to the listeners. You ready?

Ready.

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

Health literacy.

What's the biggest mistake or pitfalls to avoid?

Not trusting your own gut. You know what's best for you.

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

Constantly innovate.

What's one area of focus that should drive everything in your company?

Content, content, content. I might have talked about the UX but at the end of the day we're a content play and all we want is the best content from a variety of sources that people have the best information available to them.

Amen. I'm right there with his sister. What book would you recommend to the listeners?

There's two one which I'm halfway through at the moment it's called you True North: Describe your authentic leadership by Bill George.

Love that one.

It's so good conscience.

Gosh it's so good. Yeah.

And the other one from the wellbeing space is Why we sleep by Matthew Walker.

Interesting.

Everyone should read this. If you weren't already obsessed with sleep you will be after reading this.

Oh boy.

Even my problem her existed on three or four hours sleep has to change having read this so everyone go and read it.

Love it. Ok. There you go listeners why we sleep. And true north. All of these things that you'll be able to find on our website just go to outcomesrocket.health/goodzing and you're going to be able to find the transcript, links to those books, link to the website Good zing where you could find trusted ailments from the community that Serena has built. Serena, before we conclude I love if you could just share a closing thought. And then the best place for the listeners can get in touch with you.

So the best place to get in touch with me is either my email serena@goodzing.com or serenopp on social media. I really just want to say thank you because healthcare is really about bringing people together and so often it's quite a siloed industry so every conference I get into is the medical health, or wellness. It's actually in podcasts and groups like this and if we can bring those two together then we can really enact some really exciting change for the next generation when it comes to health. So really like if we can all work together that's where we can have really good impact.

Love it, Serena. This has been a blast. Listeners called the action check out goodzing.com for your next little thing that bothers you. You're going to find some good solutions there. So Serena big thanks to you for making time for us really appreciate it.

And thank you for having me. Stay in touch.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

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Recommended Book:

True North: Discover Your Authentic Leadership

Why We Sleep: Unlocking the Power of Sleep and Dreams

Best Way to Contact Serena:

serena@goodzing.com
Twitter - serenaopp

Mentioned Link:

http://www.goodzing.com/

Episode Sponsor:

 

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Choosing Turn-Key Biomarkers and Data to Treat Patients Better with Sathya Elumalai, CEO & Co-founder at Multisensor Diagnostics

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have a very special guest for you. His name is Sathya Elumalai. He's the CEO and co-founder at Multicenter diagnostics. Mr. Elamalai is an MBA and M.S. co-founder at the CEO for multisensory diagnostics. As I told you he's got over 14 years of experience leading product development, program management, performance improvement and new business development at MDX which is a company that he's currently leading. He's responsible for the overall product and technology development initiatives, investor relationships and has established a successful business partnership with key telehealth providers and health plans. Before joining MDX, Mr. Elumalai served as head of business development at the healthcare data analytics firm responsible for managing a one hundred forty eight million dollar predictive analytics product and implementing improvements for health insurance plans. As you could see he's very dialed into the data aspect of healthcare which is an area that we need to start paying more attention to as we turn the corner on value based care and start making decisions to impact organizations and even our employees. So it's with that that I extend a very warm welcome to Sathya. welcome to the podcast my friend.

Good afternoon. How are you.

Hey doing really well. Glad we could finally connect.

Thank you. And first of all I really thank you for this great opportunity and I think that's a great overview and I'm really looking forward to tell you more about what other things that I've done.

Yeah. Looking forward to learning so. Is there anything that I miss Satya in that introduction that maybe you want to share with the listeners.

Yeah definitely my background has been doing a lot of different things. I started off being a biomedical engineer. Like building solutions to help human lives and then I have three Masters. Everything in health care. But more importantly I spent over ten years at Johns Hopkins which is really the foundation of my health care journey. And I work closely with the providers patients and caregivers to really help them with the patients safety, satisfaction, quality improve. And I also work with several startup companies commercializing new technologies. But overall we have been or been primarily focused on bringing in cutting edge next generation technologies into healthcare and simplifying health care for patient that need.

Sathya, at the bottom line I mean that's a very noble focus that a lot of the listeners are also focused on you know improving outcomes making the entire process better. What do you think should be at the center of our listeners minds on their agenda today and what's that hot topic. What do you think there needs to be?

I think oftentimes everybody's talking about today least talking about AI and machine learning predictive analytics and all those different things but most importantly I think patient-centered care and personalized care is much more that is needed at this point of time and that's something which have been integral to my success or my journey in healthcare. And I think that's where we need to focus on having patients in the design and development of their own healthcare.

So walk us through that. What does that look like and maybe an example of how you guys are doing that at your current firm?

Exactly. So multisensory diagnostics we are chronic disease management company or you can call a digital health company with a device at the center where a lot of people are delivering care today using a more patient monitoring either like an home visit or through technologies mostly like individual devices or a group of devices that are specific to patients and their health care or help needs and everybody is taking them more individual disease specific efforts or using individual parameters to really identify what's happening with the patients. For example heart failure the standard of care is still a scale that people are using to measure the patients outcome or identifying deterioration patient's condition. But there are more to the disease. It's a complex disease which involves both cardiovascular and pulmonary issues. So that's where what we're doing is Multisensor is we have developed a non-invasive rapid medical assessment device called Multilab that can measure more than ten vital health parameters in 30 seconds non invasively so that all patients have to do is simply pick up our handheld device put it in their mouth and breathe through normally for 30 seconds and they put it back and they are done for the day. So this is a technology that is integrated into the life flow of the user without them having to deal with complex devices or apps or even a tablet because for example I always use my mom as a center because the reason for me to start Multisensor or to be into doing what I'm doing today is because of my mom and her multiple chronic conditions. So can I do something to help communicate what's happening with her health with her physician. So that's what brought us to build this device of love to tell you more about it.

That's fascinating. And listeners if you go to multisensordiagnostics.com. Right there on the landing page you'll see that device. It's a very elegant very small device used to capture all this data that Sathya just walked us through. It's super interesting Saadia you know. You're right. We're dealing with the main standard I guess the gold standard is weight using the scale. But there's a lot more. So tell us a little bit more about this device and how exactly you're gathering this data?

So basically what we wanted to do is to find one area or one region in the body where we can collect a lot of health information. So that's when my co-founder Dr. Gene Friedman. He's a professor at Johns Hopkins and me we working on finding a location and then he really is a mouth is a rich source of a lot of biomolecules or biomarkers or associated with health because it has access to breath and saliva which in turn gives access to many biological indicators of health. So we started there and we didn't want to just use or directly go into the bichemical analysis piece but what else can we do with we have the lips you're holding the device with your hands. So you are you have access to a lot of information from your hand. So we are collecting all these different physiological parameters from your breath, saliva, mucous membranes, blood vessels and the mucous membrane and also from your hand. So today we are measuring temperature, blood pressure, ECG, oxygen saturation, pulse rate, respiratory rate, respiratory pattern or breathing pattern Hatari variability hydration and parametric lung functions. These are all integral to managing a chronic condition like anything from COPD, heart failure to even certain forms of cancers where these are key parameters that a lot of people would love to have it but because they need to go to five or six different devices to get all these things. So no they are not doing it today we are presenting one device that is as simple to use as a electric toothbrush. Somebody told me or your devices idiot proof. I think that's kind of true because we want everyone from 9 to 90 plus to use it without any training or assistance or having accessories or a tablet to kind of play a Bluetooth. And most of the every data that we collecting from the device is sent via 4G using our universal IoT technology. So you don't even have to have a tablet if you don't have one. It's much easier you can use this device in any part of the world at any time. So we're actually it's like a check engine light for humans.

Love it. Great analogies here Sathya. So you guys have this fascinating pathway for health care organizations, providers, payers you name it decisions even you know local physicians to gather data from patients. Tell us a little bit about some of the results that you've had.

So at this point basically we rebuilt the first version of our device and we are ready to start a large scale pilot study at Hopkins. Our studies that we did before was with our first version of our device. In fact this device has been under development for almost 10 years because it has got so many information from that. I mean even just the other form factor was went through a lot of changes because it needs to be specific and it needs to be catered towards entire demographic. So today the data that we collected from our first version was really helpful in terms of understanding what the design and also what other things can be added to our device. And we also published a paper from that study at Hopkins. It's a randomized human study with more than 50 patients. It's called Mahd lab a tricorder concept optimized for rapid medical assessment so that tells you more about what we wanted to do and then the data is really accurate to the gold standard devices. Now we are moving in two words finalizing our technology device and taking it to the FDA.

Fascinating and Sathya appreciate you walking us through that as the listeners take this in and part of the thing that we do here on the outcomes rocket is you know we connect. We bring people together so as as folks are listening who out there can help you? How can you help them? What kind of collaboration going happen right now?

So one thing with our device it's it's a blessing as well as a challenge is it can apply to a wide variety of settings and a lot of different stakeholders are very interested in using this device because we are talking to these eight top health systems right now and you're working with seven of the top 10 pharma companies. The challenges not going to the peers yet they are the ones who are going to get most value out of our device and technology. So we'd love to connect with peers and also more importantly looking for working with advocacy groups. Right now we have great support from the COPD Foundation, as well as the American Heart Association. But what we're looking for is it's a device and technology not just for the patients but for the caregivers. So we would love to hear from caregivers and also from our perspective as I said it has a wide application and it's also a challenge. So we would love to connect with like minded people who wanted to really use our device to make an impact in whatever efforts they're doing in healthcare because we don't see anyone as a competitor. But we would love to work with even our competitors if it's going to help them to reach our customers or consumers early.

That's outstanding. So listeners they have it. If you fall into the category of those folks that Saati is looking for: a caregiver, payer, folks interested in the spot check devices - please reach out. At the end of the podcast Sathya will give you the best way to get in touch with him as well as check out his episode through the outcomes rocket website. There's always a way for you to get in touch with guests and in particular on this round, Shathya. So Sathya you guys are making some big progress here. Can you share a moment when you guys had a major setback and what did you learn from that setback?

Yeah certainly I think as being an entrepreneur there's more setbacks than successes. So basically I think the one incident where or in terms of even our device we developed it because we wanted a device that fits into my system or into my cofounder and how likely it is and how we enjoy using it or what is the impact that is creating. But we kind of forgot that the end user the consumer and the patients whether they can use it and can it be applied to a range of population who can use it and not just one set of people. So when we design we basically put in our mouth piece in such a way that we liked it and then the mobile interface was connected via Bluetooth where we felt like the bluetooth as a standard like everybody is using it. And let's put that in and then we expected that like somebody was a 70 plus I don't like my grandma still uses an iPhone so she could be able to use it. So.

Yeah.

That's what we thought about that. And then we put we started with all these basic things but what we learned from that process and with all 100 patient user feedback study and human factor engineering study that we did. We realized that we're going to lose patients after a few days or weeks if it's going to be complicated and if it's going to be uncomfortable. So we should of had patients before we actually designed it. But oftentimes that's not always possible. So that's where what we decided to have is let's have patients and caregivers throughout the care and then the product development journey. So today in addition to business and clinical advisory board we also have a patient and caregiver Advisory Board which is unheard of. So we have people who are patients caregivers and also like providers sitting there and telling us what we really need to do and how we need to design a solution that can improve adherence. Today as I told you it's simpler than brushing your teeth. And that's where what we have done is to pair one habit that another habit by providing this device right next to your brush. You get a you brush your teeth and then then you go pick up this device read into it for 30 seconds put it back and you're done. So you don't have to do anything more than that. And this change of putting in an IoT technology for 4G communication significantly improved the patient adherence because now patients don't have to bring in their smartphone or tablet to connect via Bluetooth.

There's no setup.

No there's no set up. All you have to do is they plug in a charger and then put it in an even a single charge can take up to 20 days of you can just use it for almost 20 days without a charge. So you can travel with it so it's easier. So anything that one additional step that is needed to use your product, people are going to use it. So that's what is a key lesson that we learned is to design something and have the users all as part of your decision making process.

Such a great lesson, Sathya. I feel like a lot of entrepreneurs fall into this trap of designing their dream product without having that feedback loop of their end user. I love that you institutionalize this lesson to your firm and now you have a Caregiver Advisory Board which is awesome man. Congrats on making that an institutional priority for you guys.

No certainly I would love to have every other company you have at least one or two person with a caregiver or a patient to be continuously part of even a weekly call. Just listen to it. There are people there who wanted to make a difference. And I was still part of the Corie patient centered outcomes research institute that has hundreds of thousands of patients and users and caregivers interested in helping in all these different initiatives bring them in have them part of your product development. It will make wonders for your company.

That's awesome. Now tell us about a great moment something that you're so proud of in your in your medical career to date.

There were a lot of moments especially the one where at Hopkins I was able to do like a large scale study where I was able to convince more than 150 top performing hospitals in the country to come together to disseminate their best practices. So I started off thinking about why one hospital is doing great. And then the hospital just 10 feet away from that house. I mean there are hospitals like a Texas medical center. Like you have like hospitals right next to each other. So why there is huge discrepancies when it comes to providing care and forget about the cost but even though the quality of care there's a huge difference I mean based on the headsets reading. So for me I really wanted to know will these people share the information. And oftentimes everyone disappointed like or discouraged me really to say nobody is going to share because it's proprietary. People wanted to stay up and then always on the top. Yes I was able to prove them wrong because I individually reached out to every single top performing hospitals based on three or four years of head scores under each domain of headscarves and pretty much 80 to 90 hospitals actually came for national conference at orphanages and almost 130 hospitals participated in the study. And we also published data or paper from that effort. So today I learned that people are willing to share. But we need the platform. We need a tool or technology to ensure that all the data that is presented are just translated to patient care and not just used for a consulting project.

Now well congratulations on that. It's definitely not easy to do. You picked up the phone and you got to it. And folks this is something that we all need to take a note of when everybody else is telling you now and you believe that there is a way to do it. What Sathya did pick up the phone. Get back to the basics and you'll find that it's amazing what you find on the other end of that line like Sathya did. Now is that paper available for anybody to read, Sathya?

Yeah absolutely. I mean I can put it in my linkin, I'm happy to share with anyone who can reach out to me my e-mail address is selumalai@multisensorydiagnostics.com. You can also find me on our Web page at multisensorydiagnostics.com.

Awesome. So folks they have it. We're going to be able to share that paper with you. Why not. Take a look at this amazing work that Sathya did to gather to these best minds, best outcomes together under one roof and produce a paper get access to that reach out to him. Sathya, getting close to the end of the podcast here. You're obviously working on some very outstanding projects here with multicenter diagnostics. Let's pretend you and I are building a medical leadership course on what it takes to be successful in medicine today. It's the 101 Sathya and so we're going to build a syllabus here. Four questio

ns lightning round style followed by a book that you recommend to the listeners. You ready?

Yes.

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

Definitely engaging patients throughout the design and development of healthcare. It's not similar. Even here at multisensory not building a consumer gadget that is going to really use to help you to show your steps or something but more importantly it's going to engage the patients and the users so that they can be empowered. So I would say patient engagement is key.

Love it. What's the biggest mistake or pitfall to avoid?

As I told you earlier like thinking that you know everything about what you're building and what you're providing to the consumers. I don't believe that swiping left or right on a phone app or just using a device and then sending that one data is going to improve adherence. But I think it's important that you need to say what is the real need of users and also bringing in the right technologies to support them.

How do you stay relevant despite constant change?

Talking to patients talking to users on again a lot of conferences and being part of the Koreas been a huge advantage to really seat there on huge stakeholders from patients providers and policymakers. So have been really integral to our part of it as well.

Fascinating. And what's one area that should drive everything in a health care organization?

I would say more importantly what the. Not just the what the end user ones. But as a customer you have the payers, providers the pharma. We also need to take into consideration that what is their needs are and always why, whe,n how. Those are key things that somebody needs to understand and put into practice.

What book would you recommend to the listeners, Sathya?

So since we had our candidates and more on patient centered care and patient focus care I would say there's one book by Susan Framton on putting patients first best practices and patient centered care which is a great book for somebody who is into health care into their entrepreneurship life. It is a great book to start with. There are other great ones on other topics but I love this one.

Outstanding Sathya, thank you for that. And folks if you want to get access to this syllabus that we just created for you the transcripts, show notes and links that we've discussed discuss the outcomesrocket.health/Sathya. You find that his LinkedIn profile will be there as well as a way to get that paper that that he discussed here on the podcast. So Sathya, this has been a blast. Before we conclude 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.

Absolutely. Well thank you again. I mean the one thing that I really wanted to say is I want every entrepreneur or even healthcare organizations to create something that is not complicated for this vulnerable population. Create a solution that is very simple to use something that can integrate into the life flow of the users and try to see what other things that they can do to close the gap in healthcare look specifically patient gap and I really urge everyone to join us. So let's change the culture of care monitoring. Let's change the standard of care. It's not going to be tough. All we need is the right people to be at the right time to do the right thing. So our mission of the company is to change the culture of care monitoring. And I want each and every one of you who is listening to this podcast who believe in our technology who believe in bringing patient centered care to join us even if you're our competitor as I said and talked to us let us find a way to work together to help make a difference in health care. You can reach me at my email address selumalai@multisensorydiagnostics.com. Our website is a great resource. You can also follow us on Twitter at mouthlab and also reach me on LinkedIn. I would love to connect with you guys. Thank you again for the invitation. This has been a great conversation and you made everything what I said looks so awesome.

Hey Sathya. Thank you for making the time for us. You my friend are the awesome man and we're super super glad that you're able to join us so looking forward to staying in touch with you.

Great. Absolutely. Thank you.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

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Recommended Book:

Putting Patients First: Best Practices in Patient-Centered Care

Best Way to Contact Sathya:

LinkedIn: Sathya Elumalai

Mentioned Link:

https://www.multisensordiagnostics.com/

Sponsor Episode:

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Eliminating 100K Yearly Deaths Caused by Healthcare Acquired Infections with Mert Iseri, CEO at SwipeSense

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

Welcome back once again to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I've a wonderful treat for you today. From the great city of Chicago, our guest's name is Mert Iseri. He's the CEO at Swipesense. Mert is the young turk of design. His journey started off in Istanbul, Turkey and change courses completely once he arrived at Northwestern McCormick School of Engineering. After graduating with his own degree in the spring of 2011 he's excited to embrace design and entrepreneurship to galvanize a generation into positive change. He pick health care of course to do that. During his time in Northwestern, he cofounded design for America, a national network of students that lead design studios working to create social impact and currently as I mentioned he's the co-founder and CEO of Swipesense, a company that aims to save the 100000 deaths that occur every year in the U.S. due to a HAIs hospital acquired infections. So it's with the tremendous pleasure that I welcome this fellow Chicago in, Mert to the podcast. Welcome my friend.

It's my pleasure to be here. Thank you so much for having me.

Hey it's a pleasure, Mert. And so tell me what is it that catapulted you into the medical sector.

Ever since I was a kid I knew I wanted to be an entrepreneur. I was one of those kids with the candy racket in elementary school. I was selling thing in school, I was organizing events. To me it was just what I wanted to become when I grew up. I was just sort of waiting to grow up I guess. And I believe it's a part of me that feels really really passionately about the craft of entrepreneurship is that the endgame is to truly create impact. It was back then. It is now. I hope that it will be in the future that it's about the improvement that you create in society in people's lives that are tangible and measurable. I don't get as excited about potentially selling ads online. I mean nothing against businesses that do that. I think it's wonderful it's amazing. I'm glad to have Instagram in my life. But at the same time in terms of finding the good fight I want to save lives. I want to do something that matters. And one thing that I've found over and over and over again you can walk through a house and start chewing gum or you'll probably save someone's life. It's an amazing privilege to be in health care because ultimately you know that all the sleepless nights all the hard work all the effort that goes into it. It truly makes someone's life better. It's the kind of future that I want to live in because of the change that we're creating in hospitals. So I find it infinitely rewarding to know that your work has a social impact component to it. And I'm the biggest capitals in the world. I don't think that takes away anything from the business liability if anything it adds because it's it's a tremendous joy to be a part of it for myself and all of our team members.

Mert there's no doubt that you are passionate about what you do. I love the energy that you bring. We had a chance to connect here before on some of the local happenings and you know what. It's true with healthcare being so complex it doesn't have to be that way and I'm excited to dive into some of the things that you have done and things that you've unlocked to make health care better. On that note what would you say a hot topic that you feel needs to be and every medical leaders agenda and how are you guys approaching.

Consumerism in healthcare. I think health care is on the verge of an earthquake of realizing how much of the quality of care that exists in the hospital is actually directly tied to the value of hospitals brands hospital spend a tremendous amount of time and energy to market their services by taking up the billboards and running ads and of course this is a fight. And everybody wants to capture as much market share as possible but realizing that the single biggest thing you can do is actually improve someone's experience during their care. So they become ultimately repeat customers. Thus what an amazing new idea that has to be on the forefront. The first question that every hospital CEO has asked when they started there and the last question that they asked when they really in the building is, how have we created a brand positive experience for our patients that come through these doors because we know that more people have access to information that ever before more people are talking about the time they spent in the hospital more people are recommending things online anonymously or tied to their identity. And the fact that that doesn't sort of take up the decision making process in the hospital is extremely bewildering to me. And it's you know somewhat disturbing as well. It almost shows that this monopoly mindset that has existed in health care for a long time continues to exist and hospitals that have made the leap in understand that they're running a service business that just happens to serve folks who who want to gain their health is a big shift in mindset that has to be every medical leader's mindset right now.

I think that's a really great callout and we're approaching this so you know big thing it happened listeners as you are now is this big increase in in the deductible that we have to pay that is making it more real for us.

Absolutely. Basically it's money leaving your pocket. I mean we always talk about healthcare costs versus health care prices. I think once you have a deductible they have to pay three four grand for that cost because the price and you are much more conscientious about who you see that service from. And it's again it's basic things that I don't want to wait no line in an amusement park or in a hospital. So it's not necessarily new things that hospitals need to start realizing they just need to recognize that their customers their patients have a different worldview now and they have to adapt accordingly.

Now it's a great callout Murt. So talk to us about Swipesense what are you guys doing to help these systems be more consumer centric. Tell us a little bit about what Swipesense does and how you guys are doing things differently to create results.

We have a very simple value add to the healthcare operations. We basically improve healthcare performance metrics and I like to think of these as boring things like are my doctors and nurses washing their hands appropriately and in exchange what we get by improving these metrics like hand hygiene is we improve patient outcomes. I mean everybody sort of knows that if you wash your hands more you get less infections inside the hospital but it's extremely difficult to measure and extremely difficult to change. It's a cultural issue. People don't like to be told what to do. All sorts of things that come into. But ultimately what I want hospitals to realize is we basically shift the conversation around performance indicators like hand hygiene into things that are predictable improvements. Again these are things you should worry about measuring and improving and having a dash worker. These are things that should just improve over time. So this is exactly what swipes does for hospitals. And to our point on health care as a consumer and health care as a choice or health care as something that people will now have optionality in. I think it's increasingly important that hospitals get the basics right. People go to the hospital not to spend time there but to get better. And if I'm going to have a hip surgery I want to be discharged in exactly the same time that my doctor told me to do. I don't want that to be any complications in my care and I want to enjoy my lunch while I'm there. But really number one and to first. So our organization's value is almost this whole grade of predictability in health care by basically allowing hospitals to do exactly what they tell their patients to do. And we've started from hand hygiene. We've seen some tremendous results accordingly and now we're expanding into additional bottlenecks inside the hospital.

Very cool. Very cool. Now if we dive deeper into your hand hygiene application for instance what sets you apart like what is it that you guys do to make it easier?

Very very straightforward. Hospitals today use pen and paper to solve this problem. They basically have what they call secret observers that are not so secret because their colleagues with pen and paper in the corner of Allaway but they basically just wash their beers and every unit as we do a certain number of observations per week, per month and they analyze it and nothing happens. This is our largest competition. This is our status quo. Now about five years ago, companies like Swipesense started attacking this space and now it's a very very good opportunity with cutthroat competition amongst companies. And the reason why Swipesense is different is we've sort of separated this into two problems. One of them is a technology problem. How can we install something in an affordable manner? How can we not disrupt workflow? How can we give you a sense that you have to recharge? All the good things that make the Apple phone better than some Android phone. These are things that are intuitive and well designed. But I always viewed as half the problem Swipesense basically easily implement much more affordable than your competition. But ultimately what it does differently than anyone else is that we are obsessed with what you do with this data. I fundamentally do not believe that it's good enough for me to simply give a graphic or a number to a hospital and hope that they will get better and by the way the starting point for these hospitals is much worse than people anticipated. The average hospital starts from 30 to 40 percent compliance in their hand hygiene from a journey which is a very disturbing and scary number. What it's even scarier when your task to improve this number. It's easy to get 80 percent to 90 percent. Much much harder when you're signing up from 30 and your perception is that you're at 90 percent. So we spend an awful lot of time trying to understand the behavioural economics behind why people act a certain way inside the hospital and it is fascinating. So we have the most number of customers in this space because we really took an obsessive approach into figuring out what ticks people, what motivates them, what rewards them, and ultimately will do a fantastic job in getting that predictable improvement over time versus just the dashboard and sort of a good luck wish in terms of improvement down the road.

Love that. I love that, Mert. Thanks for walking us through that listeners if you have any curiosity about this go to swipesense.com you'll find the hand hygiene module there and they also give you a nice downloadable case study where you could take a look at some of the things that they've done validated backed by hospitals that have actually gone through this process. Very cool work that you guys are up to there, Mert. Tell me something give me an example of a time when you guys had a setback. And what did you learn from that setback? What helped you guys keep going?

Absolutely you know early on our product looked nothing like it is today. Now believe it or not the reason why we're called swipesense because we had a portable dispenser and the original idea was it's as easy to swipe your hands on your pants. It's the intuitive gesture of hand hygiene. We thought all we have to do is take the dispenser on the wall and put it into a little dispenser and attached your hips and it's going from the wall-mounted phones to the cell phone. That's what we want to do and the company swipesense because it just makes sense. Turns out this was not such a good idea because health care workers have so much on them that they really don't want one more thing either of them which ID card that we're giving them right now. It's one more thing for them to carry around. And it's a big no no in our early dispensers. I mean I thought it was the most beautiful thing in the world that is egg the top health came of it this unique design and we patented the cartridge we were so excited about this moment to realize that nobody wanted it. And that's a hard thing to realize because you love your baby as ugly as she is, you love your baby. That really sort of was a humbling moment because it made us realize a very very important lesson early on. Just because the problem is there doesn't mean that it's worth solving. It was incredibly difficult to find this wearable dispenser that way to a certain amount that a cartridge that was cheap to manufacture that easily attires did not leak. We spent a tremendous amount of energy. What we didn't realize is actually pretty stupid idea. It turns out that all you had to do was build a handful of these prototypes give it to people on watch for a week for you to realize that this would never work. Sure there's these little bottles that people carry around but it's really for maybe five percent of healthcare workers and really for the 95 percent you've got to do something with the Walmart in dispenser. This is like I've said a humbling moment. But they taught us this lesson early on. So now we're incredibly skeptical doesn't mean that we doubt our success or don't have conviction that the end game is meaningful. It just means that we have very very very questioning approaches whenever we come up with a new application or a news service or a new feature. We go out there and ask some pretty tough questions for our potential buyers or users. The same with actually moved the needle for them and if it doesn't we're brave enough to say that we were wrong earlier in the process rather than you know living it out and spending tons of time and energy into making them a reality. That was a large setback it took us about a year and a half to realize this but I think I've gained about 20 years for the rest of my life in terms of the future mistakes I'm going to avoid because of this.

That's a great way to look at it. You had a setback that cost you some time but now you're looking at it as an investment that's gonna help you avoid losing more time in the future.

Absolutely every mistake is an experience as long as you learn from it. There's no such thing as failure only experiences in life.

Love that my friend love that listeners take that and implement it into your current product or focus. If you're company or even a provider for that matter working on it on a current project or a focus area before you go all the way in and bake everything pressure test it against your market pressure test it against the users before you move any further because it will save you a lot of time and give you the insights that you need to make an impact for product. What would you say Mert is one of your proudest leadership moments that you've experienced to date.

I was reviewing this and thinking through it. One of our customers held a fireside chat and we were at the Atick meeting. I think it was two weeks ago. This is the Super Bowl of infection control. This is our one time of the year where we get to meet our most number of customers and we'll be going there for five years and we're sort of is a reminder a five year anniversary or anything sort of a full of checkpoints for you to realize oh we've been doing this for a little bit you know we're. So there was my fifth time there. Obviously I grew as an entrepreneur, as a leader, as a CEO, as a student of healthcare - as I like to call it but we held a fireside chat. Where we really wanted to sort of put our thoughts to the test and we took one of our customers. We took 20 of our prospects. We got everyone in a room and we said look we're going to do something quite orthodox we're not going to moderate or lead a conversation. It's really raw and ask anything. Ask our customer whatever they would like you would like to know because we ultimately believe that they tell the story the best.

Yes.

And this is one of our healthcare network partners are based in Tennessee and she shared the story of how the first couple that they implemented Swipesense had 23 infections in the previous year 23 almost two infections per month. Yeah they implemented Swipesense in December of last year. So December 2017 and they sort of have been looking very closely for the first six months. And really this was the first time that they were publicly talking about their outcomes. And again just going into a little bit of a surprise as well because again we wanted to take a chance and truly become vulnerable in front of our prospects and say look this is because we're getting a real partner. She says since the beginning of the year we've had one hospital acquired infections in the States. And she shared with us how in this hospital now they don't talk about decreasing their HAI. They talk about infections as something that should never happen. They have this big sign you know I don't know if you have ever been to a factory but usually they'll have they since last night. Yes. Yes. That makes them more in a sort of a thing that should never happen like that number should be a big number. Every time you look in this hospital they have a big sign that says they since last infection. And again it's a change in mindset.

Huge huge change.

To hearing that from our customers say look we think differently about these things now.

Big shift.

With an organization that simply does not do this and this hospital the centers that you do not get an infection and it might happen. But it's really strange and we're going to really understand what went to the bottom of this. I thought long and hard about why I was really proud of that moment. On one hand it really is the product does what it says. Of course it's exciting and you work very hard for things like this and I think it correlating with the five year anniversary was a big milestone for us.

That's awesome, Mert.

Healthcare as a whole. I think the structures are something much larger and it sort of represents the shift of how Hustle's can't think of quality instead of using them as sort of an improvement process. Why don't we view it as sort of a never event process. Why do we tolerate these in the first place and I was so proud of that. I mean I you know I was I would always say I cried in the background but I was going to be thankful and grateful to be in the world that I'm in right now that I wouldn't trade it for anything else.

That's so awesome. What a great story. And I love the shift in paradigm you know rather than say hey you know let's reduce these to why are we having them in the first place. That's such a great shift and a great transformation by that health care facility. Big kudos to them and kudos to you and your team for teaming up with them to achieve that. Now tell us a little bit about an exciting project or focus that you're working on at Swipesense.

We recently decided to expand or capabilities as a company. Now this is again very early stage. We basically took a couple of our sensors about a year ago and started asking ourselves some critical questions around what additional problems we can solve in healthcare and we have now a number of partnerships with our customers were utilizing our technology for things other than hand hygiene. One of those solutions that we came up with is basically a novel asset tracking system. Asset tracking has existed in healthcare for a long time. These are large infrastructure projects and we're sort of trying to come up with sort of the portable version of asset tracking how can we use something that's quick and easy to deploy. That almost becomes an afterthought, a department or a one small unit and just obtained the systems for themselves. Now we've done a number of rollouts and we're sort of learning a great deal about people's behavior or sort of viewing the products the mobile devices that exist in healthcare almost as healthcare workers themselves. I mean they have jobs to do you know an EKG monitor has a job in terms of serving a patient on the pump or a wheelchair. These are all things that have jobs as limited and singular as they are and of course they need the support of assistance of an actual healthcare worker. But it's really interesting to see some of these devices have shifts just like healthcare workers. Some of them are busier than others some of them are lazier than others and it's really interesting to look at that as products inside healthcare as things that almost like workers themselves with their own needs and maintenance, certain age and retention and longevity and so on and so forth. And we're seeing very interesting parallels between devices that are overutilized and as a result have all sorts of issues versus devices that are simply over purchased and it's almost like you hired 20 extra nurses where you didn't really need them. Seeing this shift inside the hospital terms of how they operate and their capital resources. And by the way I don't need to tell you this. These are not cheap things. I mean iTunes is like a 10000 unit or it's elementary module is ours to view these things not as. That's how we've always purchased things versus really thoughtful analysis of what we do and what we don't do and plan intelligently for our next capital cycle is to me a tremendously interesting Simendinger of The state has never existed before. There was never a sensor on a particular device that told you this device gets used ten times more than the other. This was a similar insight that we found out in our handwriting hygiene when we found out that certain distances are used literally ten times more than the other announcers. Some of them barely get used up here and yet they're still there. I mean that's sort of a similar analysis on the products that you have inside the hospital has to be really really exciting.

Just a quick question are you guys taking some data output from the devices as well or is it mainly just kind of like in use or out of use type data?

It's in use not to use data so actually turns out something's location and their power of movement tells you all about whether they're used or not because it's again very predictable an EKG monitor does certain things when they're in use versus when they're not in use. So you could have a reading that tells us about what their behaviour and sort of their shifts "are looking like". And like I said treat them as almost employees of your hospital as well and make good decisions for their hiring.

Love it that's very exciting and with thousands of dollars being spent millions and billions of dollars being spent every year asset tracking is key. Why not do it a little bit differently folks and it's a pretty interesting idea that Mert is offering up here again. Mert is the CEO of Swipesense. It is all the information that we're talking about is that swipesense.com as it sounds Mert let's pretend you and I are building a medical leadership course and what it takes to be successful in health care today. The 101 of Mert Iseri. And so we're going to write out a syllabus with four questions lightning round style followed by a book that you recommend to the listeners. You ready?

I'm ready. I'm so excited for this.

Awesome. Let's go. So what is the best way to improve health care outcomes?

Peel the onion until you understand the core incentives of what you're trying to do.

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

Assuming that it works in another industry that it translates into health care.

Love that one my friend. How do you stay relevant as an organization despite constant change?

Obsessively compulsively listen to health care executives and frontline staff they know more than you will ever learn in your entire career as an entrepreneur in healthcare.

Well that and that's what we do here and the outcomes rocket so keep listening.

Absolutely.

What's one area of focus that drives all else in a health care company?

How many lives have we saved today. No matter what we decide it has to serve our patients.

Beautiful. What book would you recommend to the listeners as part of this syllabus?

The Hard Thing About Hard Things from Ben Horowitz.

Love that we've had that recommendation once or twice before and.

We can do another one then if you already have.

No, that's perfect. I mean so what's the big takeaway for the listeners. Why should they read it?

Keep going. It's dark it's ugly. It's the same for everyone. And what separates the good ones from the great ones is your ability to survive.

I love that I love that listeners. You can get this book link as well as the syllabus that we just put together for you. Show notes, transcript. All of that's available at outcomesrocket.health/mert and Mert, this has just been a blast. I really appreciate your enthusiasm. Your very fine tuned detailed to what it takes to make healthcare better. Before I conclude I'd love if you could just share a closing thought and then the best place where the listeners could get in touch with you.

Easy to get in touch with me is just simply me mert@swipesense.com. My first name and the email address of the company is you're out. I'm more than open to connecting with folks who are in healthcare who are thinking about getting in health care very approachable and have office hours that are open to anyone on Sundays and 2 to 5 to pick an hour with me no more than happy to sit down with you. In terms of takeaway, you know one of the things you realize after doing this for a number of years is the importance of the trust you have in the team and really how you should find yourself trusting and leaning on everyone else who makes magic happen. It's very easy to think that you're smart brilliant. What have you. It really humbling to realize that you really are a small piece of this puzzle and it's your relationship and the accomplishments of the team that's around you that matters the most. So I really have found to be tremendously helpful to build a dynamic inside the office that aligns people around the strong why which is in our case, saving lives. But that ultimately give people the freedom to basically follow their own interests and pursuits inside the organization. Yes we have a common direction we have a common North Star on how they should be defined by the people around the table rather than simply mean dictating. We need to do this and do that next. That humbling realization like I've said is something I've come to realize. After a few years I was very much the overconfidence. Let me get everything done type of entrepreneur early on. I've certainly loaned more to let go over the years and trust the folks that are around me. It's been the thing that has been the most rewarding for me and I really encourage all of us to take a similar approach where surround yourself with extremely smart people and just get the hell out of their way. That is the best thing you can do as a CEO your organization.

I love it, Mert. What a great message listeners take note of that and be the leader that you are. Trust your team to deliver. Mert, there's no doubt you guys are doing outstanding things. Thank you so much for sharing them with us and we're excited to keep in touch.

Very, very excited. Thank you so much for the opportunity. And I'm looking forward to the next episode.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

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Recommended Book:

The Hard Thing About Hard Things: Building a Business When There Are No Easy Answers

Best Way To Contact Mert:

mert@swipesense.com

Mentioned Link:

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Making Digital Delivery For Mental Health Improve Engagement and Outcomes with Ken Cahill, CEO at SilverCloud Health

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have an outstanding guest for you today. His name is Ken Cahill. He's the CEO at SilverCloud Health. Ken comes from an entrepreneurial background with experience in product and sales strategy, financial and channel management while holding senior roles from a successful career covering H.R., software, e-commerce, telecom to banking, atm solutions. He's extremely passionate about how technology can be used to provide meaningful positive impact on people's lives. He's worked with a number of large multinational organizations such as Gateway, HP and Dell and Europe. The U.S. and India. Ken is super passionate and knowledgeable in this space and he is focused hyperfocus in healthcare now at SliverCloud Health. So it's a pleasure to have you on the podcast Ken. So glad you could make it here to join us.

Also thank you for the invitation to come on a long time listener for some color.

Hey. Thank you so much. And so what is it that got you into the medical sector to begin with Ken?

I think it was accidental in a lot of ways but from my perspective. I met with some of the team behind SilverCloud back in its very early days when it was still a research project and the I'm thawn way with by the team that passed the team that the approach they had taken to a very difficult topic a very difficult situation in terms of what mental health culture has been and the transformation that was beginning to take on in terms of stigmatizing of the Tippoo slowed European reboot from a from kind of what I would refer to. I've often referred to as a highly medicalize family, an interesting cross-section of chronic diseases such as genetic diseases that have passed since my family but my mom was is was a nurse, midwife and a pediatric. So grown up an icon a health care background.

That's supercool.

Yeah it is. That being said my wife will often complain how the sympathy levels are quite low for any injury that she sustained compared to the level of sympathy that we would have gotten when we were kids at home due to the fact of the exposure to diesel or sensitized so moving the team. It was very clear the approach they had taken was something quite new. From what I see and you know mental health is such a significant economic and social need for us for improvement. So that was really what got me interested in healthcare and you seeing personal family impacts by mental health I think there's very few people that would be around today that would would have been actively affected by their close family members and can affect their mental health in one way shape or form.

Yeah I think that's so great. And recently we had our interview with a physician out out west. He has you know he's an Anesthesiology Pain Physician and big approach that he's taken with his pain patients is a mental health approach. So definitely a spillover effect is huge as you and your team look to tackle this space. What is it that makes you guys different?

I think the team makes us different. I'll be very honest. And you know the approach they've had to what we're tackling the approach that we've had to a small thing but we don't refer to the users on our platform as being patients we would unless we have to for the customers to understand who we're talking about but we will refer to them as clients. And the reason for that is we don't load on to terms of stigma. And also the fact that we need to treat them as being customers of what we offer. So we know they have alternatives. We know that they have alternatives in terms of healthcare in terms of utilization usage all the rest of them we're competing with other parts of their lives in terms of how they can go and watch television they can go on YouTube or Facebook or anything else like that. So as a result of that we need to be cognizant that we think give them an experience that is impactful positive and engaging for them. So that has cut us with the big parts.

That's awesome. And so you guys are working with a highly specialized team. You're creating some very interesting solutions to tackle this problem or mental health. How would you say and what would you say a hot topic that needs to be an every medical leaders agenda today as it relates to mental health?

I think fundamentally mental health is the reason that you and I and the listeners got up this morning. That is what it all boils down to. Mental health is the reason why we do or don't do anything ion this life. Everything is behavioral related in some way shape or form. I don't sort of wax lyrical on statistics but the CDC would estimate that one in four of the global population will have a noticable mental health disorder in any given year of their lives. So that's couple things as one of four of the population that is globally. So that's you know pulling out or ruling things around know conditions are there so that in any given year or somebody's life. So as a result of that it's a very very significant. We then even add in issues around chronic disease and the numbers then increase an even more alarming rate. So something else inverted commas as normalized as say diabetes care diabetes you're going to see the prevalence rates there increased around 45 percent of people who have diabetes who also have comorbid challenges around clinical levels of depression, anxiety or stress which is impacting their health care utilization, the medication adherence, their compliance all those kind of key factors which as management or executive level or or other within a health system that's impacting how we deliver care, why we deliver care and all the other elements that are there and then we look at the cost multiplier within reported him from Medicaid for delivery of a patient and he serves me it was around that it was around nine and a half thousand dollars to deliver care to a patient with diabetes in a year. But if you brought in the comorbidity which remember happens almost one and two times what 45 percent of the time in the comorbidity you're looking at that cost multiplier bringing in the cost up to about thirty six thirty seven thousand dollars a year. That's a huge increase. Huge difference in terms that you then include things like cardiovascular disease, oncology all these different elements and I you know I grew up in a kind of family environment that kind of said you know a will is stronger than any medication and was that's not backed in any scientific basis of course not. There is an element to that in terms of the positive approach acceptance and sort of the adherence but also the anxiety of communication with the clinician. You know even something like diabetes looking at things like sexual health impact that can have a family and also things around guilt and shame, things around it. What are the long term impacts of this disease and condition on my life or my parents issues mortality and other things like that. And then also looking at you know for every one person who has a has a chronic disease centre they're typically surrounded by up to six people who are severely affected by that. An example would be our wife with breast cancer and you know that the husband who is severely affected by that or other types of issues like that. So again mental health is such a huge component to unlocking chronic disease. I think it was time in Salt Cellar before that you mental health can have a bigger impact on somebody's health and a more significant impact on somebody's health. And a thousand different sensors. I think that's that's that's very true. So that's the part of what I do and have been doing for the eight years that gets me excited is the impact that we're having of people's lives. We see the impact we see the feedback we thought there was a platform now around 180000 patients since 2012 since we spun out of research. I see some other quality feedback not just constant. And it isn't just that it is about pulling people back from the edge saving people's lives and saving their marriage and all the other elements like that and I kind of mentioned in the intro. Thank you for that. But that's quite different than banking software and hardware software.

Huge. And you're making some really positive impact in this space Ken, you and your and your team tell us about that platform. Who uses it and what does it do?

Yes certainly. And so what we have developed sort of spin out from well over a decade of research and that research was coming was bringing together a number of kind of key opinion leaders in search of better experts. And I suppose looking at the big question that was there from the research was looking at the challenges that are there around delivery of digital delivery of mental health and how I suppose effectively there are a number of barriers that limit the level of effectiveness that are there and those barriers are around high levels of client or patient drop rates low levels of client arrangements and limited levels clinical approval. So essentially digital delivery for mental health hadn't worked up to that point and still argue another time still isn't working in terms of those kind of 3 criteria. So that was the overarching question behind. And that's I suppose a research thesis behind Superflat. So what the team did was they developed a platform that was focus on those engagement pieces so core was engagement and all cost and you know how were the key part of measurable change because of measurable change from client perspective. So the team builds a platform which will focused on both the engagement and the outcomes perspective. And we knew that if we could keep them engaged long enough and deliver the right content and supportive tools to them we could help them in a meaningful way the material way. So to an unfairly boil 14 years plus worth of research down we built a platform the team built platform which was the concept of set aside P.S. that was highly applied from us highly social highly interactive highly personalized and highly supportive. So it's kind of for the four pillar elements that the platform is built on. So from a patients perspective from the client's perspective they get access who is online environment that is essentially a digitization of what you would do within face to face therapy or care using text, infographics, audio, quizzes, videos and other typical content that you see to triple effort or live in an online environment accessible on multiple devices like your tablet, your desktop dedicated apps also on a smartwatch device those kind of things that multiple different interaction and touch points with it. And essentially what is designed to do is use core intervention style will be what's called cognitive behavioral therapy and that is really focused on kind of the executive function of the brain how we have you how I or anyone else will we take in information processes and we sort of you know we create an almost outcome or a reaction to it. And often what we can do is we can we can take information in and often we can run more or less of brain with computers and often will do in the wrong way. So catastrophizing or or negative thinking styles or any those kind of elements which can which can kind of spiral down a negative spiral in terms of how we take information in process and then sort of react to it in terms of a physical reactions or how we react to it in greater parts where it lives. So I as as a client will have access to the platform. I could be introduced to it by you know my primary care physician you know see secondary care specialist care like OBGYN,new and expect mothers all the way through to within healthcare organizations to amuse themselves for their own for ease for physician burnout issues and other big issues like that.

That's fascinating Yeah. And you guys are even helping providers with their physician burnt out disease.

Yeah well if if we look at it from the perspective of a lot of these large health systems we'll be self-insured. And also these are employee population as well. So it's almost double that a double impact in terms of that population group insofar as they have to pay for the health care costs of that group but also they're getting impacted in positively absenteeism presenteeism issues and challenges as well. If they don't react and also they're going to see a higher level of cost if they don't react in a timely way as well. So as a client I access the platform over typically a kind of six to eight week period of time anywhere from 30 to 40 minutes per week and essentially in doing so learn in kind of about those couples are behavioral techniques to help me to sort of have and build that kind of toolkit in terms of how I how I process the different kind of parts of life. So we've built on the platform a highly engaging platform we've built our programs that 30 programs over 30 programs across mental health like depression anxiety stress all the way through to chronic disease programs. Programs around diabetes, cardiovascular disease, pain management, COPD and those programs are looking at the comorbid psychological stressors and challenges that are there with the chronic disease as well. So the platform itself and integrates within the health system within the electronic health record. It mirrors the care protocols so becomes not a tangent to care because something that's get very integrated and that's one of the key steps that we've done it becomes very integrated within the healthcare delivery. Not a poor cause and oath but a very credible first port of call to you know that's where we've grown. You know we've over 210 organizations using the platform today across five countries and we've overcome all the sort of challenges along the road of how we embed how we connect with you know to borrow a sales force or come expression you know that what they have done around customer success so how do we make the healthcare organization really feel and be successful with using SilverCloud so you know the patient satisfaction scores, the outcomes acceptability, the usability of it. All those elements are all those boxes are being ticked.

Ah super interesting. Thank you for sharing that Ken. Now can you share with the listeners a time or a setback that you guys had and what you learned in this process?

I think you don't have multiple setbacks along the route of the majority like Lakewood or any part of any part of life. And I suppose you know there's an expression a mechanic on his or her car a cobbler and his or her shoes so in the sea of mental health company I kind of have to pertainto be whiter than white in terms of my mental health. But yes I think following an entrepreneurial journey it's difficult, it's challenging and you know some of the work that I'm trying to do in the back and the sideline as well is sort of support him a very heavily exposed thing that you're doing here. You're putting yourself out all the time trying to raise funds and having you know 99 percent of all the people you will talk to will reject you or almost reject you in some way shape or form. So it's always always a challenge to part. And I think for you know if I go back to that kind of positive feedback remember we had hired a member of the team and they have agreed and accepted to come on board and that unfortunate decided not to join us. And you know that was after a lengthy recruitment process and it was a shame. One of my colleagues James sent me over some of the quotations some of the quotes some of the feedback from the users of the platform and some of the impact that we were having day in day out and that was kind of enough to kind of say you could push yourself off and off you go. And I'm sure we've had a lot of challenges. Much bigger and much greater than that but that's always a stand out moment. It really made me understand that while we were doing was different was different than what I had done before that this was stepping into people's homes. It was impacting people, their families, their communities, the workplaces and how we were being contacted now by cities, by state and even by countries who were looking to improve the mental health of their own country. Some are looking to provide something that is a safety net a catch in terms that interventional mental health around clinical and an even more severe level of depression or distress. And then all of these large organizations, large bodies of populations and swathes of people who are looking for the positive mental health side. So things around resilience, coping skills, relationships in this sort of fast moving environment and world whereby we're constantly being connected we're also can challenge where our brains are on an awful lot more of the time than they probably were 20 30 40 years ago maybe even 10 years ago. We're seeing a lot more people looking for an ability in a way to compartmentalize why into town and why wind up at the start and at the end of a week.

I think that's super fascinating Ken and appreciate you sharing that it's tough I mean when you're in the process of hiring somebody especially a critical role you pour in a lot and that have had that person not respond and not take the role. I'm sure was really tough. I've been through that myself. It's not fun and it's wonderful that we have a team like you do colleagues that are there to remind you of the purpose and you get to remind each other you know. And in a message to the listeners don't forget about why you're doing what you're doing specially in those tough times.

Yes absolutely. You can kind of become so close on yourself that you forget what you are doing and why you're doing it. And I think often kind of the position that I have maybe it's the personality that I have as well as I can often be too even a kill to not to swing low sweet high in terms of reaction that you have to be a steady ship. And after what happens then is the positive maybe flyby or or cause overpass a little too often in terms of the progress and it's only when you maybe talk to yourself her or even other people who maybe I haven't spoken to in 6 9 months 12 whatever it might be and they kind of are asking for an update or how you guys are doing. And you're gonna able to you know talk about the numbers the impact the outcome. So we're seeing the platform now on average across our and of 180000 users clients or seen seeing about 81 percent. We'll see a clinical improvement.

That's huge.

Yeah which is just for me is phenomenal. Now is the be all end all of what we do. And no thank you. And this Congress for the team it's the there's also the humbleness as well. You know we're all will all admit fully the whole team right across the organization. So we know something we don't know everything. No there. And there's that humbleness of continued research so we'd have 20 different research trials running today depress the world here in the U.S. and Europe, the UK and also in the likes of Colombia and Argentina. So there is that acceptance of it's wonderful what you know so far. But don't forget that there is an awful lot more that you need to learn and I know that is terrible but it's often it's often forgotten that it's also celebrate the winds as well.

That's awesome. Yant can no doubt you know there's so much left for us to learn especially in mental health. Up to this point. What would you say your proudest experience to date is in what you've been doing at SilverCloud?

I think the proudest has to be the numbers. So we have a couple of large screens in the office with US the UK and Ireland which is one here in Boston and we've had screens up in the office which are essentially a dashboard which will cover things like you know how many users clients have come on and then there's just one very large number which isn't a fun size only one very large number on the screen which is a number of uses that we deliver the platform to the number of clients so far. Just seeing that take over seeing that go when we have every time it's over a sort of milestone number if you will be fifty thousand seventy five or hundreds all the way through to 150000 we try and mark the occasion whether all the team will go out at lunch or even grab a beer. We don't start pause and reflect and kind of on. That's pretty cool. That's pretty you know and that's kind of one of the that's for me is is the kind of that that the single proudest moment that I've ever had has been kind of always around that number showing that impact and then seeing over time the number growing and the pace that the numbers come in. So we all will hit north of 280 thousands clients or patients delivered by March next year. So we're just accelerating off. And you know what are my other colleagues Karen Teralba lines from that interview that she did before you know medical school was that for me and for anyone who has been but I'm very proud by the number that we have in the organization we've probably delivered more care in a shorter period of time than perhaps we could have if we all became trained as charters which is kind of a kind of humbling.

It really is. Kudos to you guys and folks. A couple notes here from Kenz share other screens and his and his offices in Boston and London and Ireland is that you've got to measure you've got to have optics to know that you're moving in the right direction and to you've got to celebrate those winds when you get to that end point. Celebrate it. Don't just pass it and go to the next one on Thursday. And can you guys do such a great job of that. If he had right now what's an exciting project that you're working on within SilverCloud health that you want to share?

That's another part of it. It's humbling to see some of the projects working with some of the organizations that are not to be too dramatic but some of the names of organizations that we're working with. I would have killed just two a number of years ago just to get a chance to talk to them who have kind of approached us or are looking to work with on some on some really exciting things around it. Either data or digital delivery or sensor technology or whatever it might be just so much stuff that makes me really excited but in terms of product to talk about I think it's going to sound boring and cliche but for us it's about scaling, it's about process element. It's about making the organization you know the old clichés succession management but it's about making the organization so bigger doesn't it no longer resides in my head or in other members of the team we're in our leadership teams heads or anyone else at that SilverCloud is bigger than all of us. And that for me is something that is very humbling but it has its self living it has its own heartbeat it hasn't some ability and that's part of the culture. So the products that we that we do is around measurement as you mentioned around the measurement of impact that we have across the content we're delivering the platform the clinical delivery and of course the kind of commercial impact that we have with the organization. So that's one of the biggest one the biggest projects that we have is is really continuing that scale as we bring on more and more organizations or more users. Is that kind of automation that sort of scale automation but without losing the touch points that can a feeling of almost sort of boy club service or organizations hopefully will say back to me when you ask them in terms of working with us.

And it's pretty great and big reason to be excited about. Now we're getting close to the end here ken. This part of the podcasts I've got four questions lightning round style for you followed by a book that you recommend to the listeners. We're going to do a little syllabus 101 on Mental Health with Ken Cahill. So hooray for it. Absolutely. All right. Let's do it. So what's the best way to improve mental health outcomes?

I think if you can still boil it down what is an outcome. I think the outcomes have to be measurable and you can't argue with numbers. So having a measurable and making sure that it's going the right way.

What's the biggest mistake or pitfall to avoid?

I think the biggest pitfall to avoid is taking yourself too seriously and kind of being closed off from what's going on outside?

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

I think the changes you say is constant. I think having that level of humbleness you know you're right every time you put the best effort forward nobody has all the right answers but humbleness are going to ask the end user that the clients the caregiver the health care coordinator kind of be open for that next little spark of genius that might come from a conversation rather than kind of being head down stuck in a box behind the laptop or whatever it might be like giving up and getting out there and trying to evolve.

Ken, that's such a great message you know I feel like a lot of us as healthcare leaders we could get pretty stuck in our tracks and we could pass by our coffee, or a grocery and we're not going to smell the coffee we get to smell the coffee and be open to those insights.

Surely.

That's a really great message. Finally what's the one area of focus that should drive everything in a health care organization?

I think that's kind. If banks that feeling of treat a patient as a client or a customer a problem for us they have alternatives in terms of care don't think they have over alternatives in terms of usage of distractions and their lives are human and they have human behaviors. So if we were talking about retail, we could look at how can we possibly improve so I think within healthcare I have to say as well.

Awesome. What book would you recommend to the listeners as part of this syllabus?

It's less of a mental health book perhaps with elements so a lot of elements of health and mental health illness and possibly a reason the old classic. Richard Francis Losing My Virginity. I think it's just a classic entrepreneur business will struggle get beaten up back at it again and stay in the boxing ring type book that is one that you can kind of pick up read and then read again in six months time and still love it even more every time you do.

That's awesome. I had not heard of Richard's book. I'll definitely be adding it to my list Ken. Listeners you can go to outcomesrocket.health/silvercloud or you'll be able to find the show notes transcript to our talk as well as a link to Ken's company and all the things that we've discussed can here to the end. We'd love if you could just share a closing thought. And then the best place for the listeners to get more information. Our follow you.

I think closer to home for me has to be you know borrowing a slogan from from Nike it's just do it. Just keep on doing those terms of innovating terms of helping improve health care and healthcare delivery say in the boxing ring. As long as you can. They've got to be. It's got to be my one. In term of contacts. Always happy to talk to anyone email address is ken.cahill@silvercloudhealth.com and thanks for the opportunity Saul.

Absolutely can and looking forward to seeing what you guys do here in the next year. Getting that name a 280000. Excited for the things that you guys are doing for patients but clients in the health care space. Thanks again for taking the time to be with us.

All of us Saul. Thank you.

Hey outcomes rocket friends thanks for tuning in to the podcast once again. As a leader in healthcare you have big ideas great products a story to tell and are looking for ways to improve your reach and scale your business. However there is one tiny problem. Healthcare is tough to navigate and the typical sales cycle is slow. That's why you should consider starting your own podcast as part of your sales and marketing strategy at the outcomes rocket. I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for and the same thing goes. If you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level meaning that the number of people in healthcare listening to podcasts is small but growing rapidly.

I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomes rocket health slash podcast. Check it out today and find a new way to leverage the sales marketing and outcomes of your business. That's outcomes rocket health slash podcast.

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Recommended Book:

Losing My Virginity: How I Survived, Had Fun, and Made a Fortune Doing Business My Way

Best Way to Contact Ken:

LinkedIn: Ken Cahill

E-mail: ken.cahill@silvercloudhealth.com

Mentioned Link:

SilverCloud Health

Episode Sponsor:

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Applying Crowdsourcing and Price Transparency in Physical Therapy with Efosa L. Guobadia, Chief Executive Officer at Move Together and John Randa, Physical Therapist at Northwestern Memorial Hospital

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. Today I have a special treat for you all. We've got the co-founders at MovementX.. First of all, I want to go through a quick introduction and then we could walk through their personal experiences and anything that I left out. But I want to introduce at Efosa Guobadia. He is the co-founder at health tech company MovementX founder of the informational web site PT Haven co-founder and co-director of the international initiative PT Day of Service Co-Founder President CEO of move together to buy 1 seat 3 for purpose organization dedicated to improving access to quality rehab medicine around the corner and around the world. He developed and led the international volunteer program ATI mission works for ATI physical therapy which we all know a national chain and he contributed a chapter on sustainability as well as a closing afterword of the book, Why Global Health Matters. We also have John Randa. He's a physical therapist who grew up in the Midwest. Here he spent some time in Chicago in our backyard, the outcomes racket backyard currently works and received his B.A. in B.S. in kinesiology at the University of Illinois in Champagne Urbana followed by his doctorate in physical therapy from Northwestern University. Now he's a big part of the work MovementX. And I'm so excited to welcome these two dynamic individuals to the podcast. Welcome guys.

Thanks for having us Saul.

It's a pleasure. So John, Efosa, fill in the blanks there that I missed anything that you want to share with the listeners.

No, you hit it. Thanks so much. So thanks for that introductions. It's a hi pleasure to be sharing time with you. I'll also use this time to give a shout out to the rest of our team from MovementX. Two to my older co-founders Keaton Rick. These are Portland Oregon Justy Angel based on at Washington D.C. and we have other team members. Meghan Roussin of Portland Red Gilbert and Scott McAfee and then John. And what makes so much of the work we do fun is the people that we get a chance to do it with someone to give them a shoutout.

Awesome I love that special shout out to you all. So let's get to the root here. Why did you guys decide to get into the medical sector?

Great question. On my end, so I think early on when I was young, my mom is a nurse and she's been since. So I think the job when I was younger in my early words from a stethoscope or something like that. So I always had my eye on the health care sector and fast forward to college young undergrad the University of Massachusetts and we forget this at the time my sophomore year, my older sister was in physical therapy school at that time. Get her clinical doc in physical therapy and I hopped on the horn with her and I said just talk to me about the profession you know about physical therapy. And in that conversation we talked about the ladder ability of the profession within one month, week and day work with different patients of different ages with different conditions. And that really spoke to me. A rules we'll talk about the whole concept is in your hands and your heart and your words to work out who and to help others. And that really spoke to me as well and through all the time and even started from when I was younger my conscious mind and my subconscious mind I was falling in love with the whole concept that our police force throughout my whole life football all wrestling cross and play lacrosse at UMass as well Parsky lacrosse and then as I talk about continue to think about moving before I was even realizing I was loving moving really thinking about movement it start to hit me. That movement is one of the most important commodities in our lives. You know one of the oldest commodities in our lives with us from the very beginning and throughout. And it really dictates how we engage with the world and how the world engages with us, how we run, how we play, how we dance, how we love, how we live and is really drive my belief that when one is able to maximize their movement capacity and maximize the moving capability able to maximize the life. So I believe that's also humanistic. So much of my work today, occasionally is based around the transformative power of movements.

Love that Efosa. That's a strong message.

Yeah, it was a great answer. Tell.

John, what about you. What got you into this into this business?

So I grew up summered Faucette just being active and loving health and wellness growing up playing soccer since I was 4. I'm in love ain movement myself and I knew pretty early on whether as late Junior High or early high school that I didn't want to sit behind a desk for my career. Just love moving and so my parents challenge me to go ahead and look into what I wanted to do. When I just whipped up the U.S. News Report article for a top job satisfaction and physical therapist is right there. So I just combined my love for being active in helping others and to wanting to be a physical therapist and haven't looked back since I decided early high school that I wanted to do this.

Love that. What a great story guys. You know without a doubt, sounds like you've landed in the right place and so you've gotten knee deep into this space with your company, can you share with the listeners a hot topic that you think needs to be on every medical leaders agenda and how are you guys tackling that?

Yeah, a great question Saul. Thank you much for and I think what's been on my mind I think was big and many health care, leaders and organizations' mind, we really need to reframe how we look at our patients. No longer are patients these passive chess pieces to be moved along, along per here you know just sort of taken in the right direction away. Consumers now and patients now they're active, they're selective and they're more aware. And I think we need to see them as such, treat them as such and speak to them as such. We really provide a and power tools around them to choose what they need and when they need surgery or consultations. Other industries do this well and have been doing this well and use in other entities and extensions like technology to enhance the doing of this well. I think healthcare is catching up, healthcare does have complex tentacles to it. Not maybe all other industries have. But a, that's simply innovation will live for us right. Simplifying the sophistication and simplify our product and pricing in a way that patients. Now we started looking at more consumers that they could help pay to know what to do what. That's on our mind much. And I think that's going to be more and more health care organizations mines as well.

So how would you say and appreciate those thoughts. Definitely that the healthcare consumerism becoming more real larger co-pays mean that more discerning consumers what are you guys doing at MovementX to help provide differentiated care?

Yeah so it definitely one of the most of us getting into it a little bit at the end there is just the cost of healthcare in the U.S. and just how much of a problem that is. And that's definitely something that we're working on and how we're addressing this is we're just trying to provide the best care possible. What we're finding is if you go to like a typical private physical therapy place, you often will be double-booked with two or three patients at once and you're just not going to receive the individualized care that you deserve. And that will likely happen is you're going to draw out the visits that you need to get better. And that's going to keep driving up costs. What we're trying to do is we're going to provide as much one on one care with highly trained providers so that we can get the patients faster to reduce costs overall and improve outcomes as well.

So I now piggyback on that to piggyback on what John said and so so directly asked the last question and that is set up team and talk about MovementX and and what we are we know. So I always like to say. So the context and the concept and the content so that the concept of what we are really starts with any you know MovementX and movement is a fundamental value that I talked about earlier maximizing a movement that allows you to maximize your life. You know what we sometimes see in the world there is a bit of resistance to being healthier to be an active so along with so many other institutions organizations and just people talking about history, we want to make sure that we're encouraging people to be more active in moving. What our company does is not just encourage but enable people to be more active. You know that x40 start playing with the concept of it allows you to explore the world around you, allow you to experience the world around you. And we talk about ex being at the intersection of your best movement and your best life. You know so understanding our fundamental value and then as an organization it can't be the next thing that is building the architecture around that fundamental value. And that does what we're doing there is to bring in rehab clinicians and patients together on a centralized platform, that's one of the front of innovation for a MovementX decentralized platform allows for communication, documentation, payment and scheduling so we like to say create efficiency and effectiveness for people on both sides of the treatment table the patient or the provider so the patients are able to go to our site search for PT what they need, Number Beppo contractors empower choice as well. And what's also important for us is creating an environment for providers to have the support they need to very flexible, flexibly and per the passion and inspiration that got them into physical therapy in the first place and to build their clientele. And what this is ultimately about is quality effective experiences. We're taking the product a physical therapy a movement health or occupational therapy and rehab medicine to where the patient is and where that product could be more functional whether it's their home. Wether it was a fitness of where's the office. And to your question of how we're solving this. We just officially launched a couple of months ago Saul in about April. So we're pretty exciting times. So what we're seeing is, thank you so much, but what we're seeing is mission vision and being manifest that leaning into these pinpoint to the fulfilling of fundamental values being manifested when a patient has back pain or shoulder pain. So now they're able to go to our website within 24 hours 48 hours and they could be seen it that they had a PT come to their home. You know so we know all the research shows especially some of these musculoskeletal issues will be able to address it quicker rather than later. It is just a chance for that. It gives you a better chance here that the chance for that to become a chronic issue. So we're doing that to collaborate. That's what we're working on. And the final point is that the best that does that this best still has communication collaboration with other disciplines is specifically refer to other disciplines that interconnectivity is healthcare at its best.

Very cool, very cool. Thanks for walking us through that guys and. So in other words you guys are crowdsourcing PT and providing with that crowdsourcing some price transparency which is highly needed.

I love that word transparency because early on in this to be noted early on Rexy a cash pay eventually going to be integrating with insurance. Right now, we want to minimize the overhead in some of the operations that insurance entails. But we believe that's a front that we could go in often is because a lot of healthcare now as you do pay a copay but you get your sessions it is like that or your care and then a lot of your bill comes three or four or five or six months down the road. While a know without much understanding with this sort of control and personalization of selecting who treat you. You know as a provider that work with that provider to personalize your treatment plan and the scheduling of that and paying upfront session or be a bundling payment. You have more awareness of your cost and we think that's very important. And what we do to make that makes sense for the person will provide super bills to patients so that they could submit well received and super a bill to their insurance company or payer to get cover.

Yeah that's pretty cool. And another thing that comes to mind Efosa, John is you know I went to Walgreens the other day and I had like a little thing going on in my shoulder. I had like a tough workout my trainer kind of beat me up but it was good it was good and I'm like Man I need, I mean like when those little massagers so going to walgreens and I go to the section where the little massaging things and the yoga stuff is and I find it and there's a little like sticker on it that says you can use your flexible spending account or flexible savings account. Oh wow that's cool. So I carry it in my wallet and I go to the counter and I give it to her and boom wala! So just a thought for you guys if there's a way that you guys could somehow make your offering FSA approved this would be a big big motivator for people.

I love that thought.

Especially on the cash front right.

Yeah. Yeah I love that so much. We talked about that peripherally but in your anecdote in your experience. I want to bring that back center Saul. You know into your point what you just describe is also bringing and putting the product in that choice where people are you and Walgreens so well there's Walgreens or CBS or whether you're a yoga studio being able to get the treatment or the ability to schedule a treatment, whether it's virtually no platform or the places where you spend your time. And then again not everything needs to be a 60 minute treatments session. It could be a 20-30 minute work or just do a quick assessment. Look at the functional presentation of the structural presentation of sole shoulder also has serve a region maybe is thoracic region as well. So your findings and not get a treatment in 20-30 minutes and voila. And I could do a quick payment to your FSA. So that's a whole deal with without company building the infrastructure for that to be possible.

I love it. I love I love the idea guys and and I think this platform has the opportunity to be very disruptive to the current cost models and lack of efficiency as you've stated in the way that things are are organized today. All right so guys you're at the beginning of your of your journey but you're making some big strides. Give us an example of some setback that you had up to this point or maybe with a previous experience that led you to start this company. Take us to that setback. Let us know what you learned?

Absolutely. So at my first job as a physical therapist, I was literally like two hours a day for my 90 day reviewer they would just release me and I wouldn't be supervised. But I was seeing three patients at that one time and became focused on one of them. And then I saw another one was doing lunges with too much weight. And he ended up tweaking as quadriceps muscle so that that was not ideal but so certainly I could have been paying more attention and we would have been unable to prevent this situation. However looking back on it I just like zooming out and taking more of a macro approach. I started thinking about just what was going on with having to be responsible for managing three patients at once and that there is just an inherent problem with that. So when I heard about the mission of MovementX this year I just absolutely jumped at the chance of hopping onboard this wonderful company just to try to change that experience that I can give patients by being able to be put in a situation where I can just provide one on one specialized care for patients.

That's awesome man. So the opportunities there for you. The opportunities there for all patients and listeners, a take away that you should get after on some of the things that have been shared today is just that doesn't matter where you're at and where whether you be at the middle of your career the beginning or close to the end. There's always an opportunity for you to take it to the next level and make outcomes better and Efosa, and John are an example of just that. So I applaud you guys for your courage. Now what about the other side of the coin you guys have talked to us about a setback how about it. What are your proudest medical leadership moments that you've experienced today?

I'll jump in there. So some of my works also the nonprofit sector. So like you mentioned a afront and one of my moments is that I was able to be a part of early on and now I'm just hanging on being an inspiration by the professional large so cheers to work you so 2015, I did a trip around the world around 22 countries in eight months you know amazing and the idea is the hope was to create a montage mosaic of health service physical therapy rehab medicine different cultures around the world get a sense of the similarities differences and enjoy the beauties that lie within those and use that to be a better person and to do good in the world so great trip. That's be a long conversation for a long time.

We'll save that for when we meet and have some coffee together.

That sounds good, that sounds good. In month four, I was in Peru. I was doing some work in Iquitos, Peru which is only Amazon River you can only approach it by boat or by plane. And while I was in the Amazon while I was in Peru this one day in Iquitos I was taking a boat tour the service site. So I was on the Amazon River taking a boat to the service site and so a laso on his boat on my way to the service site this idea that had been in the back of my mind for some time simply shot to the front of it. The idea is this what will challenge students to conditions of the physical therapy profession around the country and around the world to do an active service on the same day and what will challenge those people willing do an active service share the moments happy images have connections made main line on social media in different websites. What might that look like a need for the bond within our profession. What might that look like in me for the bread of our profession to the world at large. So one of my co-founders on MovementX I called him and I emailed him as soon as I got back to the mainland that day about the idea and he was just so positive about it he said not only do we have to do this, can't not do this. So we started the other co-founder for MovementX Keaton Ray and we started this initiative called PT Day of Service and 2015 and the first year we had 28 countries participate in all 50 states in the U.S. the second year we had 42 countries participate in all 50 states in the U.S. and last year we had 55 countries participate in all 50 states in the U.S.. Now we have a team of 20 plus people that work on it now and just a friend within the profession that we know you know for any other professions just come together daily and serve locally in their community for a global affect. I'm proud to be part of the community now serving around the world.

That's awesome. And I love that you're like Yeah I was on the Amazon River I'm like you just had me at Amazon river man. Yes. Then it got better from there. You guys have done some really great things to create a movement around the profession of PT so something to be proud of. Congratulations on that.

And I'd even like to jump in on an experience that relates to that of faces with absolute machine and he started another non for profit organization called Nu together along with Josh D'Angelo that they built what was a couple clinics and a day last year right Efosa.

Yeah we will rebuild and rehab clinic in a second most populous city in Guatemala.

Not kidding. Love it.

So I was fortunate enough to receive an email from a Efosa last winter asking me to join him this year January turned me in a wave in Guatemala to serve for a week at the clinic they had built and that was without a doubt the proudest medical experience that I've had. We're literally providing physical therapy in its purest form and which the patient was getting the exact care that they needed without being rushed in and out of the door and there was just absolutely incredible to give this experience to patients when this was likely their first time just encountering another health care provider where we could listen to their problems. Just so empowering just just to see the difference we can make. And fortunately I was able to meet the other three founders and MovementX with Josh D'Angelo and Keaton Ray also being on that trip as well.

That's awesome. There's no doubt you guys are up to some really cool stuff I was looking at the PT Day of Service folks if you're curious go to ptdayofservice.com, you'll find them. You could find movement X at movement-x.com and no doubt you guys are doing some really fun stuff that is both meaningful and impactful and that's what we seek to do here. And the outcomes rocket has shared the stories of those who are doing what you all are up to. So why don't you tell us about. I mean no doubt MovementX is the exciting project but within MovementX, is there something that you want to share to the listeners about what you guys are doing there a project or focus?

For MovementX. Yeah. So like we launched three markets, where in Chicago, we're in DC and we're in Portland and I really know the infrastructure of the organizations that bring to providers and patients together where it's most functional. So one thing that we always say there's five fronts of innovation that we operate 5Ps you know one piece is a platform. The second P is that people know those are providers and everything. And really all people were really empowering our providers. Secondly is innovating payment. So when the people schedule our perceptions are looking at different a bumbling package and things of that nature. The 4th P is a product you know what's been fascinating for me to really think about since I graduated PT school in 2010. This is not just for PT this for healthcare is a really appreciate the whole spectrum of healthcare, or too often we focus on a hat. Wait for a person to be injured or sick or hurt you know especially with a professional physical therapy and really much of the medicine not just wait for somebody to be hurt to come to us or to see to see us. How can we work with people to help optimize you know their system and their body so soul comes in I see so again I look at his functional presentation structure presentation as a workplace environment, how he's doing what he does whether it's run, jump, play the whole night, based on what he tells me subjectively replacement I see objectively and basin with them talk about creating a precise and personalized plan for him. So we're creating programs we have a program called optimize it which would be the case and also creating us also small or mode programs or or Chronixx excuse me know which for work with different regions of the body and then it becomes about partnering with different companies organizations again where we can take that directly to their employees. So that's stuff that we're cooking in the oven right now Saul you know we're going to go vertical and the market Stodden mentioned before we go horizontal geographically.

Super exciting and listeners, I just had a chance to go over to movement-X and signed up, I created an account. It's pretty seamless. You go in and you could see all of the the PT providers that are available licensed and ready to service you. I think you guys should check this out movement-X. Check it out. It's affordable. And hey, if you want to do your part to make healthcare better try this out and consider it your way of doing what's best for health care but it's also going to help you. If these guys by the time you listen to this podcast I'm sure they'll get their FSA platform ready. So give it a shot right guys. You commit to getting this done?

I'm committed. We're going to look into it today.

I love it. I like it well. Whether or not it's done it may be done in there but you should check it out folks. I love the layout and I love where this is going guys. Thank you for sharing it getting close to the end of the podcast here. Let's pretend you and I are building a medical leadership course and what it takes to be successful in PT today is the 101 of these amazing folks at MovementX. So I've got four questions lightning round style and then we'll follow up by your all time favorite book. You ready guys?

Yup, fire away.

So maybe we'll do like what on one. You guys choose. So what's the best way to improve healthcare PT outcomes?

I think it's taking the time and listening to your patients. There's a quote by an infamous physical therapist Robin McKenzie and he says listen to your patient they will usually tell you the key to resolving the problem. If you'll only listen to them.

Love it. What's the biggest mistake or pitfall to avoid?

I think it's becoming complacent and straying from your mission vision and values.

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

I love that question. I think the key to that Saul is pulling parallels from the market or pulling from other markets or industry whether they were parallel or seen with less perpendicular orders Amazon or Uber or AirBnB or anything that you could think of. I always like to say Gretzky has his quote, "I wouldn't past the pop where the person was. I pass it to where the person was going to win". That's a mind and a mentality that grabs us.

Love that. It's one of my favorites. What's one of the areas that should drive everything and a health care organization?

I'm going to cheat on this a little bit but when I see what I'm about to say I see them all interconnected. I think one has to be product-centric and product believing the greatest options and products for your customers. When I see mission-driven you know a lot of things I learned from my time the nonprofits spaces for-profits need to be more like for-profit and in terms of being mission-driven and nonprofits need to be more like for profit when it comes to operation. So being mission-centric and mission-driven being customer-centric, lighting up your customer absolutely every single day, building this amazing experience around them. Amazon talked about that a lot. And then one is key I think all industries and all employess will do this better as being providers-centric. You know really feeding your routine nourishing providers and haltered conditions because when they're nurtured when they're supported when they're empowered that's going to lead to a better care and that's going to lead to better results. That's going to lead to a better everything. So as much as you think about our customer and our patients movement we think about providers as well.

I love that. And what would you say your all time favorite book is guys?

Mine is called the Winter fortress it's by Neil Basque and it's not a book about business or health or wellness actually it's actually a historical novel about a group of soldiers in Norway taking over a nuclear power plant that the Germans had taken over to prevent a nuclear strike. And it's just there's so many overarching undertones of just the grit and determination of the soldiers going weeks without eating and having to sleep in blizzards outside. And just like when I just think about just if I'm complaining about waking up at six thirty in the morning to go to a meeting or just try to keep building business growing I just have no reason to complain when I compare to what they do.

Great. That's a great example John and I'm a big fan of thinking about business and also the care process as seasons. Every one of us will go through different seasons and those that are able to endure the winter will come out on the other side stronger and ahead of the pack. I love that example.

I love. We're definitely going to have a dual copy Saul.

Let's do it.

On my front, Count of Monte Cristo is my favorite book, I'm not sure how nice.

That's nice.

That will be to the crowd, I love that book as Alexander Dumas and I just love so much about that book. What I'm currently reading now. It's a book called Peak by Anders Ericsson who talks a lot and Robert Poole is a writer on there. It talks about deliberate practice you know the right practice the right amount of time over x amount of time to achieve mastery of deliberate practice and Gladwell actually based a lot of a good amount of work on that with the outliers. Look at the whole 10,000 hours a minor injures versus research. Keep my ears open.

Love it. Great recommendation. The syllabus listeners is here for you. Just go to outcomesrocket.health/movementx and you'll be able to find that there along with the transcript, links to the resources, their websites and all the other things that we discussed and the books. You're going to find that their outcomesrocket.health/movementx. John, Efosa, before we conclude, I love if you could just share a closing thought for the listeners. And then the best way that they could get in touch with you.

Absolutely. Just in general I think just chase your dreams and embrace being uncomfortable. If you have aspirations of starting a business don't build it. Want to learn to play an instrument. Go play it. I just feel like it is so easy in this day and age to become content and not continue to grow and learn. I think we tend to underestimate the time we have in a day but overestimate the time we have in our lives. Just like paraphrase a quote from Les Brown he says the graveyard is the richest place on earth as there is so many unfulfilled dreams. Because someone is too afraid to take their first steps and carry out their dreams. So just go out move and do that brother and then yeah just in terms of contacting me just email, it's johncranda@movement-x.com

Awesome. Efosa?

Yes I love it.

Take us home baby.

A quote center founded by the Irish poet David White. Here's a quote. How do you know that you're on your own path, you can't see where it's going. That's how you know and how do you know they you're doing something radical, your path disappears. So the balance of always having vision but embracing the unknown and living your unique journey and humor. That's what my heart and that's on my soul.And there's three cogs I would say it is a wake abuse day. Know your daily joy and pursue it each and every day. The second a second cogs on my heart and his whole concept of living life with intentionality. You know like like John said solo or you want to build something build ability think the best person for job explained to the boss he or she is sure why you are. I'm 32 years old now. What I've seen in my 32 years is that opportunities don't come around to see them twice. At the very least they don't come around twice in the same form so when an opportunity comes around in the form misspeaks they're not grab by it's hair tops to say in our everyday play and move as much as you care. So those are my thoughts they're my email address is efosa@movement-x.com. It's been the highest of pleasure your time if you so and also share your time with your listeners. Thank you so much.

Hey it's been a pleasure having both of you. Efosa and John. Thank you all both for making the time to be with us and we're excited to keep up with your success because your success means the betterment of outcome. So appreciate you guys taking the time to be with us.

Thank you Saul.

Thank you Saul.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast. Once again as a leader in health care you have big ideas great products a story to tell and are looking for ways to improve your reach and scale your business. However there is one tiny problem. Health care is tough to navigate and the typical sale cycle is slow. That's why you should consider starting your own podcast as part of your sales and marketing strategy at the outcomes rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

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Recommended Book:

The Winter Fortress

The Count of Monte Cristo

Peak: Secrets from the New Science of Expertise

Best Way to Contact Efosa:

LinkedIn: Efosa L. Guobadia, DPT

efosa@movement-x.com

Best Way to Contact John:

LInkedIn:  John Randa DPT, OCS, CSCS

johncranda@movement-x.com

Mentioned Link:

MovementX

Move Together

PT Day of Service

Episode Sponsor:

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A Novel Therapeutic To Cure Dry Eye Disease with Dr. Jeffrey Nau, CEO, Oyster Point Pharma, Inc.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there's one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That's why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

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 again because we have a wonderful guest today. His name is Dr. Jeffrey Nau. He's the CEO of Oyster Point pharmaceuticals. Doctor now has been building his career and developing novel innovative therapies for a disease of the eye. With over 15 years of experience working with biotech pharma and med device companies. Most recently he was V.P. of clinical medical affairs at Optotech. Prior to that he was mad science director at Genentech working on the development of Lucentis to transformative drug for retinal disease. And Dr now has raised more than 150 million in equity for startups such as Janiero corporation, Acuity pharmaceuticals and Neo Vista inc.. He has numerous patents in the space as well as peer reviewed publications and I'm so excited to welcome Jeff to the podcast. Welcome.

Well thanks Saul. Thanks for having me on.

It's a pleasure to have you Jeff. Now what is it that got you into health care to begin with?

Yeah it's a good question. So I started out really I think as most young college students do you know heading down the premed path and wanting to go into medicine just based on my my love for science and I loved learning about the human body was very sports growing up and I loved all the exercise physiology and just learning about the you know muscles and bones and things and so I ended up taking a little bit of an odd path from that. I had a small class that had an elective in my undergrad which was intrinsic biology and I end up working in the medical examiner's office and within a couple of weeks, I found myself doing autopsies and really being into the sort of I would say elbows deep into medicine and learning about the human body from a different aspect and that ultimately translated into some work that I did while I was in school and sort of paid my way through school working with the organ transplant team that was often in there and really was into the surgical aspect of medicine. And then when I went off to school never really thought about the pharmaceutical space or the Medtech space and all always very focused on the clinical piece of it. And for a whole host of reasons that we could probably spend a whole another podcast on, ended up deciding to veer off and head down that pharmaceutical path and first I think it was kind of a patch to figure out where it was going and it just snowballed. And I've been here ever since and you know I really love being at the forefront and cutting edge of developing either drugs or devices and found myself in ophthalmology for almost my entire career.

Amazing what a winding road but always very focused on health care. So fast forward to today, Jeff you're working on this exciting project at Oyster. What do you think today is a hot topic that needs to be on every medical leaders agenda and how are you guys addressing it over there?

Yeah I think one of the things that's going to be it's really important because we are kind of in a time right now and I think there's probably a cycle to it if you were to look back through the annals of medicine where we have these bursts of innovation where things really move forward fast. You know we have karty therapy we have CRISPR technology. On the oncology side of things, things are moving so fast it's really exciting. Usually that followed by some period you know some cooling off period where things kind of slowed down a little bit and then we have another burst of innovation. And I think one of the things that I think is really important to keep in mind is we have to continue to be innovative and we have to continue to think outside the box. You know one of the nice things about Oyster Point you know we're a venture stage startup pharmaceutical company focused on treating Dry Eye Disease and it's through a real novel pathway. So for years and years we've had therapies that treat Dry Eye Disease whether it's over-the-counter or prescription eye drops. We're very focused on the topical aspect of delivering medication. What oyster has done is really transformative in the sense that we're treating the disease and going through the intranasal route. So a very what I would say disruptive and novel approach where we're actually leveraging the body's own parasympathetic nervous system and we're still doing pharmacological stimulation of the nerves inside the nose which then ultimately result in tearfoam formation. So fascinating things like these where for years and years we've had sort of a stagnation and we've been very focused on attacking a disease in one particular way and then all of a sudden something changes through innovation. And now the whole field shifts you know and if you think back to a decade ago, harnessing the body's immune system to go after cancer was always a thought we always had these ideas. I remember learning about it when I was an undergrad but until recently the terms CRSPR and carti have not been on everybody's tongue like they are today and so I think fostering innovation always looking for new approaches to go after a disease are very important. And I think it's just evidenced by the exciting kind that we're in where now really the treatment is just really blowing up right now.

Super fascinating. Thanks for walking us through that Jeff and what keeps your innovation juices flowing?

I think the thing that really keeps me going is you know I started out going into medicine wanting to help people. You know I love the patient contact aspect of it. If I was to say the one thing that I'd miss being an industry versus being on the clinical side is I loved interacting with patients and being able to help a patient whether it be just through consultation or whether it be actually delivering a treatment. I really enjoyed that. And so I think that staying on the cutting edge of innovation, you have to keep that patient peace in mind and that patient interaction piece and you always have to remember that if you're doing the right thing for the patient, not only from the standpoint of bringing these novel treatments to the forefront but also thinking through all the form factors that go into therapy and how patients are receiving health care today, how patients may or may not like whatever therapeutic option you're bringing to the table because of the way that they're going to either attain it or ultimately utilize it. And so I think there's ways to innovate around a lot of different aspects of medicine not just if you're focusing on the actual treatment itself but how are these patients getting these treatments and how are we keeping them on these treatments and so I just think that there are so many opportunities to really keep yourself patient-centric focused and innovate around that sort of holistic idea and that that's really what keeps me going is working in companies you mentioned in my past that I had worked at Genentech and I worked on this amazing drug who sent us that literally stopped people from going blind. And so to be able to see that type of innovation come to fruition and see the impact that it has on people take you back to when you were in the clinic and you were you could do something to help someone and that just feels great. And that's really what keeps me going.

That's awesome Jeff. And no doubt it you guys are doing it yet again here with oyster not sure what detail you do go into it but maybe if you can dive into some of the things that you've seen early on with this new approach at Oyster for dried eyes.

Well so dry eye disease is becoming a little bit more I would say at the forefront of people's minds. One of the things that Oyster has benefited from with the most recent drug approval in the space is Shire's Xiidra™ and they've launched an eyelove™ campaign which is really all over the TV and radio ads and people have seen Jennifer Aniston talk about her eyes. And many of your listeners have probably seen these commercials. And so you know the concept of Dry Eye Disease and just eye health in general is really taking a big step forward by all of this marketing that's going on now and this market is really massive. So there's a few markets in the pharmaceutical space where you have 34 million patients that are out there with Dry Eye Disease. You have about 20 million of them that have a diagnosis of Dry Eye Disease. So there's a huge number of patients that just are not seeing in eye care provider. And then of those 22 million or so that have a diagnosis there is literally about less than 2 million patients on prescription medications. And there's a whole host of reasons behind that but it's just a giant unmet market where there's opportunity for a really good therapy to come to the table. So what we're trying to do is really bring the therapy to the table that gets at the root cause of the disease and really impact the disease early on in its existence. And the whole concept of Oyster Point is really by putting healthy tear film onto the eye on a regular basis. So as you and I sit here and we're just sort of breathing in and out of our nose that airflow going across our nasal cavity causes basal secretion of tear film and so when we have things like stuffed up noses we often get dry eyes. The whole host of other things that can cause it. But the one thing that is keep in mind is really the reason that you and I don't have Dry Eye Disease although I'm not a hundred percent sure you don't have dry eye disease is have healthy tear film. And so having that healthy tear film is really the key to not progressing down this slope of inflammation and sort of a chronic dry eye disease state. So what we're doing here is pharmacological stimulation of the trigeminal nerve that causes tear film formation and we think that by keeping these patients moist with regards to their cornea over time will alleviate many of the problems that we see with patients with Dry Eye Disease. And so it's a disruptive approach. No one else has ever gone through the nose to try and treat with a pharmaceutical and it just makes sense from a biological perspective because we're really we're sort of harnessing the person pathetic nervous system to do our work.

That's fascinating. And how are the results coming out. Are you seeing that it's working?

Yeah. So we had some early studies that gave us a glimpse at how well it worked and it was eye opening. No pun intended but it was it really was exciting for us to see that we actually have completed a 160 patient Phase 2 trial that will be presenting in July. And although I won't give away the results I will tell you that the results are pretty amazing and we're super excited to present it. We think it's going to be a game changer. Really excited about the opportunity to bring another therapy to this patient population because it's just growing. You and I are both sitting here right now probably looking at a phone or looking at a screen. The screen time is going up you know Dry Eye Disease is not going away anytime soon. And so there is a real need in this marketplace for another therapeutic option.

That's awesome. That's so great. Thanks for walking us through that Jeff. And really neat that you've taken on this approach and as the market sits today, is this something that is also reimbursed by insurance providers?

Yeah so the two products that are out there right now which are topical drops are reimbursed. We expect that our product once it gets the market will be reimbursed as well.

In the same way?

Yeah.

Got it. Very cool. Very cool and very innovative to think about this. And folks take a note from Dr now here and the things that him and his team have done, there's another way. When you thought that the only way was topical, they found a different pathway to have the same result or even better. And so think about what you could do to approach your problems in a different way and use this episode as inspiration to do just that. What would you say a time when you maybe had a setback it could be at oyster, it could be at one of your previous roles and something that you learned from that setback?

Yeah. One of the examples that I always tell people is we started a company back in the early 2000 timeframe called Neo Visto which was a therapy that was brachytherapy so we use a very small strontium 90 pellet that was on an applicator and this applicator was placed through a surgical incision into the eye and held over a neo vascular lesion for patients with Criddle new vascularization due to age related macular degeneration. The surgeon would hold this applicator over the lesion for a number of minutes. We deliver a very focused dose of radiation and then they take the applicator out and we close the patient up when we were starting that process. First of all, this was pretty 9/11 before we had a lot of safeguards in place for how radiation traveled throughout the world. But I think we also went into this study as mostly pharmaceutical and medical device folks with no real radiation experience and so we very quickly underestimated how hard it was to a transport radiation and radioactive material throughout the world to do clinical trials. All the people that needed to be involved. I had never heard of a radiation physicist before and I quickly figured out who those guys are and what they do. And I think without really understanding what we were getting into we were pushing forward so fast that we didn't know all the players that had to be pulled together. So we got ourselves into a situation where just to start a clinical trial rather than getting one physician under contract we had a RETNA surgeon, a radiation oncologist, a medical physicist, a surgical suite, a hospital, the local authority who oversaw radioactivity in the area. You were over your head in just contracts for one cent there let alone doing a massive multicenter Phase 3 trials throughout the world. So I think where we failed there or where we made a mistake there is we just didn't get to know all of the intricacies of that particular technology fast enough or really enough to be able to be proactive in plan. So it probably caused us some some delays once the machine started moving forward we got pretty good at getting all those sites up and running and how they were going to work. But I would say if if we had a lot more institutional knowledge beforehand things would've went a lot smoother, moving forward.

That's fascinating. And now you sort of build those learnings into what you're doing at Oyster and I'm sure the level of due diligence you took it even to the next level.

Yeah.

Now that's really great Jeff. Thanks for sharing that. And how about the other side of the coin. Right. That was a setback. Tell us about one of the proudest leadership experiences you've had to date?

Yes. I think one of the one of the other things that I touched a little bit on the forward was that I feel very passionate about the patient aspect of developing new therapies and making sure that you're always doing what's in the best interest and what's right for the patient. And if you sort of lives live by those rules and when you have big questions that you have to answer, if that's always the basis for how you're going to answer those questions, you'll you'll likely make the right choice. So one of the things that when I was a Genentech when we were developing sent us there was a cry to use the drug and infants that were born with this condition called Retinopathy of Prematurity where they have a blinding condition when they're born and without receiving therapy such as Anti-VEGF therapy immediately their retina can be basically damaged for the rest of their lives and in many cases these patients, these very young patients are just going to be blind for the rest of their life. And so the physicians out in the field were using drugs off label to treat these patients with maybe not the best safety profile behind it, but they were doing the best that they could to help these babies. And we had this drug Lucentis that we knew could help and has the potential to help. But it certainly wasn't approved and it was very risky for the company to go down that pathway as you can imagine. So I'm going to tell you that one of my proudest moments from a medical leadership perspective ultimately ended in failure. But it successfully took proposals up to the very highest level within that organization to allow for these babies to get access to the medication. And unfortunately for you can imagine legal reasons and some risk tolerance reasons it didn't move forward but we were very, very close. It almost happened and that was a proud moment for me and the team there really sort of pushing through when we knew that we were going to face them adversity and trying to get that approved. But trying to do the right thing anyway.

That's pretty cool. Jeff you were sort of at that juncture of your passion for patients and also your passion for innovation and pushing the envelope and you're just kind of in-between both then even though it didn't come to fruition. You were pretty darn close and the outcome was the right outcome even though it didn't work out as giving them access to that.

Yeah. And then I think that that's it's important. I think it's important for a lot of people to understand the people who work and in this industry by and large, they're the same folks that live in your neighborhoods and they have the same level of commitment and concern about really improving people's lives. And you know I think there's there's times when the farm industry gets a bad rap for being very focused on profits and finances and things of that nature. But I would say by and large throughout my career, I just always run into people that really just want to do the right thing and really want to bring something to the table for patients and the ones that are most successful are the ones that really live and breathe that mantra and are focused on that line of thinking.

It's a great message. I agree. You know I do feel like pharma does tend to get that bad rap but it's great to hear from folks like you Jeff to level set and give people an opportunity to revisit that paradigm. I too have I've met tons of great people in pharma. I would agree with you. Now tell us obviously oyster is your exciting project. So rather than dive into that deeper maybe you could just give the listeners some ideas so that they could continue in their innovative pursuits.

Yeah so I think the one piece of advice that I would give to people is never stop thinking about what's next or how you can move forward and prove something. I don't you could put a price on momentum. I'm kind of always in awe of some of these folks that are serial entrepreneurs and how they just have that momentum and drive to move forward despite any obstacles that get in their way and they're always thinking about innovative ways of tackling a problem. So the people are the most successful of also probably had the most setbacks and the most adversity. So I think the biggest piece of advice I would give is just continue with that momentum and keep going forward. And you know I often tell my staff you know when we have certain little setbacks whether we have comments from the FDA or we have some interesting data that might make us pause for a second that look, these are the bumps along the road and the end of the day people look back at most of these projects with 20 20 hindsight and just think it just happened and it was just organic the way it happened but it really is momentum moving forward, overcoming some of these hard times really embracing the times when you're successful. Just don't stop innovating. We need a lot of really smart minds out there to continue doing what they're doing and bringing new things to the table. You know I just read an article the other day that was sort of the history of the CRISPR technology and I was around when there were some setbacks in gene therapy in Philadelphia where a young boy had passed away. I was developing a drug that was a small interfering RNA at that time. So we we felt that pain. But look where the industry is now and there was a setback there but we're about to go through sort of an amazing and transformational period in medicine.

That's amazing yeah. What a great message Dr. Nau. And I always think of momentum as well. And you either have forward moving momentum or backward momentum. There really is no plateau. I am a firm believer that plateaus are they don't exist you're either moving forward or back. And this advice you've given all of us here will definitely serve as inspiration to keep moving ahead. Let's pretend you and I are building a medical leadership course and what it takes to be successful in medicine. It's the 101 of Dr. Jeff Nau. And so we're going to write out a syllabus lightning round style with four questions followed by a book that you recommend to the listeners. You ready?

Sure.

Awesome. Let's do this. What's the best way to improve health care outcomes?

I think the best way to improve healthcare outcomes. And again this is this translates into all areas of life is to go out and build relationships and build relationships with your target audience whether those be patients or physicians. Good relationships with those that you do business with. Make sure that you're networking. Make sure that you're building relationships where others trust you. You'd be amazed at how many innovative projects come out of two people sitting down and having a coffee and talking about something completely innocuous and then all of a sudden some transformational breakthrough comes into one or the other person's mind. So build these relationships, foster them, make sure that you're talking about things that you're thinking about with others to the point that you can. But I think the way that we improve healthcare outcomes really is it is not single individuals but it is a massive team of people moving forward and I benefit from thousands of other people out that have either come before me or are moving in tandem with me. So there's holing up in your office is certainly not going to move the needle not for the patients and certainly not for your company.

It's a great message. What would you say the biggest mistake or pitfall to avoid is?

I think this is another one that translates to areas outside of medicine which is make sure that you're listening. And you know we're told often from a very young age like our mothers that you need to listen but that's not the type of listening that I'm referring to. I'm referring to the step back. Allow the people in your organization, allow the patients, allow people to have a voice where they can contribute. They feel like their message is heard before you interject and give your opinion and allow that team approach to happen by learning how better to just sit back and listen and then to contribute after you've allowed the rest of the group to come to the table. And so I think one of the biggest mistakes or pitfalls to avoid is really to stifle that process and to as a leader to be able to step in and say here's what I think we should do. What do you guys think. That's one of the biggest mistakes I think anyone can make because they're not listening and taking the other inputs and then disseminating those back to the team in a way that you know is going to drive things to move forward. So I would say you know not listening is one of the biggest mistakes or pitfalls to avoid.

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

Yeah I think that one of the ways to stay relevant we touched on earlier is really to continue to innovate. And one of the nice things that I really love about Oyster Point and other companies that I've been involved in is you know we're really at the forefront with oyster. One of the beautiful things is it's just disruptive and very innovative approach that no one else is going down that path. So we're really at the sort of tip of the spear with regards to leveraging this pathway to treat this disease. And so for us maybe fortuitous that we're in a really great place to stay relevant and not from that perspective but I think continuing to innovate, continuing to do the right thing for the patient. Continuing to always ask "Is there anything else we need to be thinking about" is how you stay relevant.

What's one area of focus that should drive every thing in a health organization?

I think I already touched on it which was as a leader I think it's really important we often get tied up in the sort of nuts and bolts of day to day operations but I often think that it's really a good thing to do which is to take a step back with your team and make them do something that helps them understand the patients that they're trying to treat, whether that be taking a day off and for us we're in the ophthalmic industry and so you know we take them to some of these organizations that help people with low vision. Having them understand that there is a person on the other end. So you know I often tell my team look we have a great drug. But now you have a responsibility and your responsibility is to bring this thing to the market and it's not a responsibility necessarily like in the shareholder responsibility it's a responsibility because there's literally millions of people out there that need another therapy.

That's a great great piece of advice there so listeners in whatever company you're in. Or even as providers you're at the front line of this so the reminders constantly there for you. Take away some time to be able to remind your people and refocus them on the reason why you're doing this which is the patients. What would you recommend to the listeners.

I may be slightly boring in that I am not a fiction reader and I think that's where the science piece comes into play. I'm actually right in the middle of a book called 1491 right now which is about the Americas Before Columbus came to the shores. I would recommend that by an author by the name of Charles Mann and had just finished up reading. I think it's an older book but I hadn't seen it when it first came out a book called Guns Germs and Steel by Jared Diamond which is a great read as well.

Awesome. Some great recommendations listeners you could get all of the shownotes, transcripts, links to the resources discussed. Just go to outcomesrocket.health/oyster and you'll be able to find all that there. Jeff this has been a blast. Love if you could just share a closing thought with the listeners and then the best place where they could collaborate with you.

Yes so I think we talked about a lot of different topics here but my thoughts that I would share with everyone or just continue to do innovative things, continue to collaborate even if you have a product where you think or therapy that you think. Okay we just got to get to the finish line. Always keep thinking about you know is there something we're missing. Is there a different way that we need to do this. Pressure test it, poke out. Because you'd be amazed how many things change through the process and don't come out at the end the way that they came into the system and so continue to innovate. We need innovation. Continue to work and collaborate with others. And you know last but not least continue to keep that patient-driven focus in mind. Not only when you make decisions but with your company keep them focused on the fact that they have a responsibility to bring these therapies to the patient population that's out there. And there is a responsibility that you're not pouring lattes. This is a very important task that you're working on. I think just within about a week or so we'll actually have a Twitter feed. We'll have a LinkedIn page, OysterPointRX. We also have a website, www.oysterpointrx.com. And you can send us a note through our info section on that page there as well.

Outstanding Jeff. This has been a true privilege to connect with you on this, not only the novel therapy but also your thoughts on leadership and improving outcomes for patients. We wish you guys the biggest success and looking forward to check in again here in the next year or two to see how things are progressing.

Yeah we were happy to check back in and let you know how things are going Saul and I appreciate you having me on.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast. Once again as a leader in health care you have big ideas great products a story to tell and are looking for ways to improve your reach and scale your business. However there is one tiny problem. Health care is tough to navigate and the typical sale cycle is slow. That's why you should consider starting your own podcast as part of your sales and marketing strategy at the outcomes rocket, I've been able to reach thousands of people every single month that I wouldn't have otherwise been able to reach if not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That's outcomesrocket.health/podcast.

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Recommended Book:

1491: New Revelations of the Americas Before Columbus

Guns, Germs, and Steel: The Fates of Human Societies

Best Way to Contact Jeffrey:

LinkedIn:  Jeffrey Nau

LInkedIn:  Oyster Point Pharma, Inc.

Twitter: @OysterPointRx

Mentioned Link:

www.oysterpointrx.com

Jennifer Aniston’s chronic dry eye story | it’s time for eyelove™

Episode Sponsor:

Female Urinary Incontenence Resolved with Bill Gruber, President and CEO at Solace Therapeutics

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 have an amazing guest for you today. His name is Bill Gruber, he's the president and CEO at Solace Therapeutics. They are startup company in the female urinary incontinence field. Bill is the president and CEO of interlace medical. While at Interlace, he raised over 20 million dollars in venture capital for the development and launch of devices for the treatment of abnormal uterine bleeding caused by fibroids. The company was purchased by whole logic in 2011. Great milestone for them and Bill has had extensive experience in venture capital fund raising organizational development product development and commercialization for rapid growth businesses. His mind is where the puck is going and it's a pleasure to have Bill on the podcast today because he definitely comes with that medical device angle that many of you all are interested in. And so it's going to be a pleasure to walk through some of these hot topics with Bill. I want to give Bill a warm welcome to the podcast. Welcome my friend.

Thanks Saul. Great to speak with you finally. And thanks very much for having me. I greatly appreciate it.

Absolutely my friend. So Bill anything that I left out of your intro that you wanted the listeners to know about you?

Yeah there's a lot of scar tissue that comes with all of those all accomplishments. It's all rosy. It's not all rosy. There's a really tough sessions there.

Hey man and we have a section here in the podcast where we will jump into some of the setbacks and excited to dive into that bill. But why did you decide to get into the medical sector to begin with?

Well after college I got a job with Procter Gamble and was selling everything from soap to diapers. And after five years doing that I wanted a change to an industry where with something the more cerebral and also something where I might be able to have a larger impact on people's lives. So Boston Scientific at the time was recruiting heavily on the consumer products and ultimately that's where I went and I was up to Boston Scientific for just about 10 years.

Wonderful. Bill we share that I actually also started with a Cincinnati based company sent to us and I was selling soap and floor mats. And I know the feeling right. That feeling that hey you know I'm doing a great job here but I want to do more. I want to have impact.

Exactly exactly.

Totally feel you there man. So what would you say Bill you've had some success in the corporate world. You've gone into startups and have had success, some good exits there. What's the hot topic that needs to be on leaders agendas today and how are you approaching them?

From my situation, I'm more I've shifted from big company to small companies so much more entrepreneurial and I think there are three things that really have us focused everyday and that's regulatory reimbursement and fundraising hurdles so as we try to build these companies and get products to market the new normal is that you've got to get through regulatory a huge huge bar and then immediately thereafter its reimbursement. But none of those happen unless we can fundraise from venture capitalists or family funds or private equity or anybody else who can give us capital to do that.

What a great raw response folks it's a lot of people go into business and want it to just work. They have an idea it's going to work but Bill definitely takes us through some things that are super important you want to dive a little bit deeper here on some of those Bill and your recommendations to people that are wanting to start- advice the company.

You know I think first of all the tough part here is to think about the exit before you even begin is first, right. I think one of the big issues is that people start with a great technology and then jump right in. And they haven't thought through the whole problem yet. And I think before you start a company you have to really recognize what are all the risks right regulatory risk reimbursement risk you have biologic risk biologic risk. If that does your when you actually help a patient right then ultimately you have marketing risk competitive risk. Are there competitors out there that you're going to have to unseat. And in the end do you have exit risk to somebody want to actually buy you or does everybody already have a device and you're going to have to go this alone and compete with big companies like Medtronic or others. And so I think understanding all those risks and having a plan to mitigate all those risks is super important when you're starting out a project like we do.

It's a great call out Bill. I'm a big fan of thinking time I learned this from Keith Cunningham and I schedule a couple of times a week an hour to just think through risks, opportunities. And it really helps. You know I feel like we spend a lot of time being reactive in business and if you do some schedule thinking time and are really differentiate you from others out there what are your thoughts on that though?

I agree, that's my treadmill time right. My workout the morning I get all of my work thoughts done right. And so that's why I can't miss a workout because otherwise I don't get my thinking time. So that's really important to me.

I love that man. I love that you've connected it with your physical well-being. Great idea. Can you give us an example bill of a time when you guys improved outcomes and created results by doing and thinking things differently?

I think everyone understands that with medical device companies we have to deliver new products that are less invasive less expensive and safer. You have to have all three of them. I don't think you're going to get by today's world without having those three you use to be able just to come out with some new widget. The doctors would buy it and everything's fine. But I think the world's changed. Historically in the companies I've worked for we believe that the new normal for product development is to have a core competency and conducted clinical trials. And I think that's new over the last probably 10 years or so we've got to prove to the world that what we built works. There's two ways to do it you can do that with commercial success you could just launch it and hope it works and then the world all says this is fine or you do clinical trials and show with data. I think if you fail at the commercial success it's tough to get a second chance. You end up with a bad birthmark on your device and then selling it again after you've fixed it is really hard. I think that if you start with clinical trials it's a safer strategy. At interlace medical as well as therapeutics we focused on conducting clinical trials to release new products without doing these adequately I think just set ourselves up for failure. So and I think we have three constituents all that want that data right so those are the patient the doctor and the payer. Right. So with the patient, the doctor and the pair we've got to really attract those folks. And the problem is as startup company is the clinical trials take money time and talent. And so that's tough because it made more money across the board for us. We just have to raise more, expect to raise more capital. Expect to take more time which uses capital so that goes back to fundraising, right. So I think that if we get the data the clinical data overcoming the hurdles of regulatory reimbursement and fundraising because the fundraising or the people I get money from are going to want to see that same data that those three things are made much easier. So I think we just have to develop a core competency of getting data and that wasn't something that was apparent to me early on 25 years ago when I jumped into this business. But it's definitely the way of the future in my opinion.

Yeah Bill that's a great call out in today's market. We're looking at a lot of different options. We're looking at a lot of shifts, right. We're dealing with digital therapeutics we're dealing with digital technologies and the appetite for venture capital to get into a device company has really decreased. Can you talk to that and your thoughts around that bill?

So let me just rephrase your question so you're saying that's the change in healthcare the hurdles have changed?

Not the hurdles but what has changed is the appetite for venture firms to invest into medical device companies because of the time frame that it takes to see a return?

I totally agree with that and I would say that not only have we watch many many medical device venture firms go under over the last 12 really since 2008. We've seen a real shift in where everybody's getting cash and so that shift now has gone to fewer and fewer venture firms. We're now seeing more family funds coming and participate which is a surprise. We've seen private equity firms that would traditionally only invest in public companies. Those folks are now doing earlier and earlier things because they're not finding the valuations in the public markets that they want to because a lot of the stuff is overpriced and then that's critical to the new market which is strategics. So big companies like Medtronic Boston Scientific and others are actually realizing that in order to see more new innovation come from startup companies they're having to participate at earlier and earlier stages by moving some of their R and D cash to do more venture investments. So I think in those three areas we certainly see that.

That's super interesting Bill and yeah I mean when you get into a large company like Boston or Medtronic, it really becomes more difficult to have that agility that a small company like Solace has to innovate and why not shift funds to a company like yours to form a partnership. So listeners think about that, as you build your company if you're into the device space. Think about what Bill just said. These are pearls that you're not going to want to forget because in his triad that he talked to you about research and reimbursement and the money, you're going to want to keep that in mind. Bill maybe we should level set with the listeners about Solace, right. I gave a little blurb about it but maybe you could help finish that idea. What does Solace do? What problem do they solve? Who do they solve it for?

So the current company is focused on devices for helping women who are incontinent when they laugh, lift something or cough or sneeze. And so the problem there is that it happens to men as well but as we get older our bladders are less elastic. And when we have a insult to the top of the bladder with high pressure that our research can't withhold the urine and we leak and the company long before I got here because this was a bit of a restart when I joined but the company had come up with a device to help attenuate pressure. And what we're doing is simply adding an air filled balloon to the bladder with 30 cc's of air it floats top of the bladder. And every time you laugh cough or sneeze the balloon acts as a shock absorber and it reduces the intra bladder pressure to a point below which is readthrough can now hold it back. So it just looks passively there. Right. And it works incidentally it's placed in the doctor's office and the patients come back on an annual basis and have the old balloon taking out a new balloon dropped off. So it's it's quick and simple and easy and it's reversible. So that adds to the safety component. So we go back and look at it. Is it less invasive? Yes. Is it safer? Yes. And is it cost effective.? Yes. So we're trying to check all three of those boxes.

Got it, very cool very cool. And as we think about the reimbursement piece is this something that insurance pays for is this a procedure that is considered more than you pay for it on your own?

It's a great question and I think that's a huge issue is probably a separate podcast actually that the issue is that we'll have to go out and get a category 1 code for the Medicare Medicaid population. We had a vision the whole procedure to be approximately fifteen hundred dollars. That's with doctor fee and everything else included into that. But what we're seeing in the MARPAT we're seeing in the marketplace more recently even in the last five years is all these patients are now in high deductible plans right. I mean 2000 3000 4000 dollar deductibles we have for example a 4000 deductible here but the company pays into a health savings account. Two thousand dollars a year.

That's generous.

So the problem here is that if we come out any of us come out with a procedure that's a 50 100 dollar procedure. We're never touching insurance money anyway. It's all out of pocket till we get to that 2000 dollar 3000 dollar deductible. So for us we'll go up the Category 1 code for the Medicare Medicaid patient and we'll see if we could get a hickpick's code for those also who may need it. But at the same time we expect that we're going to be patient pay initially. Right. And so we'll have to go to high aesthetic markets, right. We'll be going to markets in Southern California, Arizona the Texas markets end up in Chicago and Atlanta. So you know I think there's people out there with high disposable incomes who have quality of life impact from this condition and so we're going to go there first. And I think we'll see some good results.

Yeah I think that's really interesting Bill and as we think through this segment, I don't know the thing that kind of pops into my mind is like the vasectomy model. Right. Like insurance doesn't pay but you want to impact the quality of your life in a certain way. It's reversible and you're targeting a market that can actually pay for it.

And I think the other thing it goes right back to outcomes right. So now that we're all beforehand insurance paid for it. So we weren't as engaged in the efficacy for cash, right. But now since it's all coming out of pocket people are patients are shopping for health care much more aggressively and their expectations for efficacy are much different than they used to be when they didn't have to pay theoretically it was all running through an insurance company. So it's life's different now people have higher expectations a shot for what they want. They want to see the data before they write the check. Now the reason for more data so again as we have watched the evolution of health care and healthcare delivery I think you know we have a new constituency not just going out and selling catheters to doctors anymore. The patients a big portion on this.

Such a great call Bill definitely a great call out that we all need to be very aware of. Tell us a time when you had a setback. Bill you alluded to this at the beginning. What did you learn from that setback?

So you know I've read a lot of setbacks and I've learned a ton I think I was vice president of sales and marketing at a company called core tech which was Aspinal products company after I left Boston Scientific we are making a peak implant for lumbar spine fusions and a group of us join the company after that undergone numerous organizational issues and some cash issues run out of money and the product was a terrific idea. However the investors were pretty tired within the investment. They had that for a long time and they were focused on trying to get the company sold and they thought the best way to do this was to generate sales as fast as possible but this product wouldn't approve. It needed a PMA trial and so the company shifted its approach away from developing that implant into something that they knew they could sell which was sourcing cadaver bone implants for spinal fusions. We shifted the company over to focusing on coming out with instrumentation and sourcing the cadaveric bone for these implants and we spent years developing the business we've grown the sales from anywhere 6 million and then ultimately close to 10 million bucks. And the company sold but it's sold for a fraction of what the investors had in it. They get hindsight we should have never taken our eye off the ball right. They should have mopped up the company or are really focused on getting that product out because that was the big value creator was that. So I think what happens is if you start chasing revenue in hopes of just getting an exit you haven't solved the problem, you haven't improved outcomes right you've jumped into the same kind of market that everybody else is in and if you really advanced anything. And so that was great learning for us. You've got to pay attention to the problem you're trying to solve and not just the revenue.

That's really interesting and thinking through it. The distinction made here listeners will highlight something very important rather than chase the revenue chase the outcomes and it just very much in line with why we're talking here is if you're after just dollars more than likely it's going to be tough to get an exit. But if you're after outcomes and you're improving them for less money, smaller incisions less time you're more likely to have that exit success. What a great lesson. BELL Thank you for sharing.

Yeah, I totally agree with your comments.

So what's one of your proudest medical leadership experiences today?

Actually the work we did at interlace medical. This is a company that developed the device for moving fibroids from inside the uterus and women who had abnormal uterine bleeding and we basically just started it with a thought that we looked at six different areas within women's health. When I am just started talking to doctors which is the most vexing problem you have made and started asking them if you had a device to remove fibroids, tell us kind of what what it should do.? How long should it take? How big should it be, how long should it be? Can we use energy? Right. Can we use cautery? What is it that we can do and we just kept asking and asking I would go to urology and gynecology meetings asking doctors you know about this and in the end they helped me write a product's back right. It must have all these things must be able to move or a fibroid of three to five centimeters in ten minutes or less. You know they just basically wrote what the spec was and I had come from the vascular world. I had no no information on women's health and so I had to learn it myself. And so once they gave this spec to us we went out and hired three independent design firms and said here's the spec, come up with as many ideas as you can that achieve the specifications and they gave us back 60 ideas and so we put in a provisional patent on 60 ideas and that create a barbed wire around the space that we wanted to operate in and then we hired we hired an engineering team but only after each of these groups gave us a prototype of the one they liked the best. The idea they like the best and then the engineering team or internal guys took those three prototypes and then started working from there. And then the key for us was as soon as we had a working prototype we went in and did clinical trials and when I say clinical trials we did six patients and we were humbled because the thing did not work the way we expected we would just get our head handed to us and then we go back and spend a month just grinding through all the problems and then immediately we go back do four or five more patients again. And it was only after we did this four or five times that we really had nailed the product design and it was a super symptomatic device. Ultimately, whole logic came running and they took what was a 1 million dollar and trailing 12 month revenue for us and they drove it to where it is today probably around 200 million dollars a year it's become the standard of care.

Amazing what a great story. Congratulations on that win Bill.

Thanks.

And the thing that I take away from this and I think listen you got to think about this too. There's no secret sauce. You know you just got to do the work you got to, you know Bill got out there. He listened to the customer and he tweaked and tweaked and tweaked and stayed in the game until it worked. And I feel like a lot of people either don't listen to the customer and they fall in love with their ideas or they tweak tweak and give up. And you've got to do both. You got listening you get a tweak and stay in the game. What would you say right now Bill you know at Solace is one of the most exciting projects or focus that you're working on today?

I think our focus right now is to get the get our existing product through FDA. And so you know we're a one product company with 18 people here. We're all focused on getting this through a new clinical trial and getting FDA clearance and getting it into the market once we can get it in the market, we'll work on expanding indications and going from there. But right now that's our big effort. We are seriously focused on regulatory reimbursement and fundraising. That's my world very simple.

Bill, I admire your tenacity and your focus. A lot of people just want to have it now. And the thing that I admire about you is just that you see you see where it could be and you're working with your team to get there. So I just want to encourage you to keep doing this because the product definitely solves a problem that a lot of people are starting to have.

Yes. And in fact it goes after those people over the age of 50 primarily and that's a huge population bubble that's growing quickly.

Absolutely. So let's pretend Bill you and I are building a medical leadership course and what it takes to be successful in the business of med device today. It's the 101 of Bill Gruber and so we've got four questions lightning round style followed by a book and a podcast that you recommend to the listeners. You ready?

Ready.

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

I would say spend as much time as possible defining the problem. Once you think you have a solution, test it to failure as much as you can on a benchtop in clinical trials long before you go out to market with it. Clinical trials help you figure out whether it's actually going to work, whether you go back to the drawing board test, fail, test, fail.

Love that. What's the biggest mistake or pitfall to avoid, Bill?

People who start with the technology and run around looking for a problem to solve. Somebody gives them this great plasma energy and then they say let's look where in the body we can cook something or cut something or do something else. They haven't started with a problem they started with a solution and then my friend.

Amen. How do you stay relevant as an organization despite all the change?

I think companies have to stay nimble. I also think that we ought to keep our egos in check. For us here we seek failure to learn what we need to do to be successful. You always have to be willing to change as fast or fashion and the market is changing. As I say to my kids you've got to get comfortable being uncomfortable.

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

We love bad news early when we love to fail here we love to fail fast. I think if people are always trying to give you the good news that things are rosy, when they're not, it's a huge disservice when you cannot cover problems early you're going to win. If problems wait and nobody tells you about them until the end you usually have fewer options and the options you do have are really expensive.

Bill if I were to ever decide to climb up Mount Kilimanjaro you're somebody that I had tapped to join me.

Thank you.

Because it's life on the line you know and that's what it is with a startup company. And good news early is an amazing thing that I'm taking away from this conversation and sharing with my team, listeners. Hope you do the same. Though what book would you recommend to the listeners?

So the book I would recommend comes from more of an entrepreneurial side which is Negotiating with Giants. By Peter Johnston and I think it's for us, we're a small company and yet we negotiate with huge vendors we negotiate our exits with huge medical device companies and that's just a great great book because it gives you terrific perspective as all the things you need to be doing to give yourself better leverage with the big guys.

Well Pearl would you say you took out of that book that you want to share with the listeners.

I think it's developing a network within all the people that you want to work with and negotiating with a big company, you don't just have one person there you need to build a group of people in there that you have good relationships with and good trust with. People buy from people in the end right and they aren't going to do it overnight and they aren't going to do it when they're pressured to do it. So to think that you're going to walk in and sell a company to Medtronic tomorrow isn't going to happen. You're going to need you know it your two worth of developing relationships and them watching you have success and be having candid conversations.

Love that. It's the saying build your well before you're thirsty.

Ah I like that.

Bill, this has been fun. I always leave these conversations with the feeling that man I wish I had more time. Where here to the end. But I'd love if you could just share a closing thought with the listeners and then the best place where they could get in touch with you or follow you.

Yeah I think the big push for us always is know what problem we're trying to solve. You know with all these devices there's always scope creep. Right? And so come back and really revisit the problem you solve and don't get group-think-going stir the pot with your tame pushback. Somebody should always be playing the devil's advocate to make sure the groups going in the right direction and we don't have a bunch of yes men because that just doesn't fly. So best way to reach me probably LinkedIn. I do get all my LinkedIn requests. And I do my best to try to make sure that I'm growing my linked in group and that's how I reach out to a lot of other folks are pretty it's linked to user.

Fantastic. Bill this has been a ton of fun listeners if you want to get the show notes the transcript the links to Bill's company as well as the links to the resources that he's recommended. Just go to outcomesrocket.health/solace, S O L A C E and you'll be able to find all that there. Bill, just a big thanks to you again for spending time with us.

Great thanks for having me on it really appreciate. It's great to speak with you.

Thanks 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 could get together to 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 and be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book:

Negotiating with Giants

Best Way to Contact Bill:

LinkedIn: Bill Gruber

Mentioned Link:

Solace Therapeutics

Episode Sponsor:

Using Deep Learning to Transform Radiology Practice with Kevin Lyman, Chief Operating Officer and Lead Scientist at Enlitic

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. Today I have an amazing guest for you. Someone that's had a contribution in healthcare in a lot of ways from the bench to the frontlines. His name is Kevin Lyman. He's the chief operating officer and lead scientist at Enlitic. Enlitic is a medical Deep Learning Company. And twice named one of MIT technologies reviews 50 smartest companies where he applies deep learning to the early detection of cancer. Kevin is also the founder of the inventors guild a team of over 40 students from 10 of the world's top universities who earn course credit and money consulting for startups. Competitive at heart, Kevin is a former professional Halo 2 player and was once the world's highest ranking Warlock in World of Warcraft. Not an easy thing to do ladies and gentlemen. He has since focused his energy elsewhere winning over a million dollars in the words from hackathon and business plans to competitions. And now he's with one of the most forward thinking health companies, Enlitic. So it's a pleasure to welcome you on the podcast Kevin.

Pleasure to be here and thank you for having me.

Absolutely so anything that I'll leave out there in your intro that maybe you want the listeners to know about you?

No, I think you covered my background pretty well. It's been a long journey to end up in healthcare but I'm pretty excited to be in the space now.

Hey man that's really great. And you know I'm just curious why health care. Like how did you end up here?

Well I come from a family unfortunately with a lot of medical disability. In particular I grew up caring from my mother who loved bed down for multiple sclerosis and so that had me sort of growing up in that environment where I was forced to recognize the importance of patient care and that exposed me a lot to being in and out of hospitals and needing to care for in different ways just coming very close to that type of problem. And throughout the remainder of my childhood unfortunately a number of my other family members suffered from many different types of cancer and other rare abnormalities. And so it's always just been something on my mind. But even outside of that the most important thing to me has always been use cool technology to solve important problems. And in the quest to do that, I had started a couple of companies one of the machine learning space on the medical device space and running both of those concurrently. I've been introduced to Jeremy Howard the original founder here at Enlitic and he just really got me inloved with this idea of the intersection of those two things of machine learning and medicine and really just made me realize that even being an engineer in today's world, I have an opportunity to be a doctor to then ever since I've just been really in love with that idea.

That's super cool. And what a great story of how you ended up doing more work within medicine and and folks Kevin's been a speaker at TED MED. He's also been a participant of the hive. So he's he's doing some really neat things here in healthcare. So thanks for sharing your story of how you ended up here. So sorry to hear about your mom and sort of the hardships and it sounds like these are the things that really kind of formed your basis your empathy which I think is something that is missing in many health tech companies. So really great to hear that that you do have that I couldn't possibly agree with that more and I appreciate you saying that.

I think that's probably been the biggest learning experience for me being in healthcare that unlike any other industry I've been in, empathy is more important here than anywhere else. And every decision really needs to be made with the mind set of how will this impact patient down the line.

Man I couldn't agree with you more. So tell me Kevin, what do you think today is a hot topic that needs to be on every the leaders agenda and how is Enlitic approaching that?

Well I think I'm obviously a little biased here and I'd say that intelligence and I think that that's probably becoming increasingly more and more unavoidable from pretty much any health care professionals perspective that AI is attending Ubiquiti and it's getting to the point where these promises really are coming into fruition and very, very quickly. But given that that's something that is really on its way in I would say the thing that people really need to be worried about right now is how to prepare the infrastructure for the largest for AI but for all of these other technical innovations that are right down the road if we don't set up our systems now to welcome these new tools in, now we're going to have to deal with that in the future. And even though we don't know exactly what all of these solutions look like today I think we do have a reasonable idea of what needs to be done to get our infrastructure into place to actually implement some of those solutions. And so as far as actionable things go today I think that's really what should be on everybody's minds just infrastructure and planning for that inevitable upcoming future.

Kevin, I think that's such a great point. In fact I'm putting together health care meetings starting in September where our theme is innovation is implementation in healthcare. And you got to be able to implement and you've got to do it well for the sake of the listeners, Kevin, I love if you could just level set everybody on Enlitic. I don't want to assume that everybody knows what you guys do who is Enlitic, what problem you guys solve, who do you solve it for?

We're a team of about 16 data scientists and fulltime radiologists out of San Francisco along with a team of about 60 plus part time radiologists that work with us and we develop clinical applications of artificial intelligence. We do this sort of all across the spectrum of digital diagnostics but our primary focus is within radiology and so we train neural networks and other forms of machine learning models to interpret medical data primarily medical images and text in order to assist radiologists and other diagnosticians with the clinical diagnostic process and that can mean a lot of things. But in general we try to enable them to perform diagnoses faster more accurately and in many cases with insights that they otherwise couldn't. And a lot of our focus up to this point has been BORGIALLI in chest imaging. So building solutions to read things like just x-rays and chest CDs but we're increasingly expanding that aiming for whole body coverage over the next three or four years hoping to have models that regardless of where the images and what type of study it is ideally have something that can work with the doctor to enable them in that diagnosis. And I think there's a lot of many very different types of solutions. We've implemented to this effect. But for the most part they're usually focused around trying to spot things within the images and help radiologists understand what those are and how to treat them.

Outstanding. Now thanks for that level setting listeners check out their website. Go to www.enlitic.com that's E N L I T I C, dot com and you'll see some of their applications. Some of the news, some of the updates, their mission. I think it's really interesting the way that they're using deep learning as a tool to augment the work of radiologists and it's pretty inspiring stuff that you guys are up to there Kevin. Tell me can you give us an example of how you and your organization have created results or improved outcomes by doing things differently?

Yeah I think that this starts to play a little bit back into that whole empathy thing but one of the big insights that we've had in working on these problems is that AI is very much a user experience problem that I think a lot of people like to look at AI development as being hardcore software development. I think when you are very close to the field it's very easy to assume that but it's an incomprehensible amount of very intimidating math, a lot of software that might require a lot of specialization to understand. But what I think the helpful way to look at it is that the art of building AI is really building black boxes. It's building a system that is really good at taking a given input and extracting a desired output from that. And so once you've built that black box, the remainder of the problem really becomes what do what you want to go into that black box and what should subsequently come out of it and to train that black box requires lots and lots of examples of that input output pair and so very quickly it becomes a problem of working with people more so than crafting good software. So we've taken this approach then of building our own network of radiologists and building our own tools that these radiologists can use in order begin to label historic data to generate this input output pairs that we can then trade models on. Then we've had to go this route of building all of this in-house because while tools exist that can be used for these purposes they don't really enable you to be very expressive. And another very important insight that's come out of this is that you can collect all the data in the world but ultimately it's meaningless if you didn't ask the right question when you were collecting that data then I like to use an example of that in the interpretation of just expertise where we find that a lot of people these days are trying to train models to identify things like tuberculosis in a chest X-ray. But unfortunately people don't diagnose tuberculosis with just the x rays and so it's a little jumping the gun to try to shoot right for a model doing the same that what people look for as far as TB goes in a chest x ray or signs they look for consolidation of calcified lung nodules, plural of fusions, things that are indicative that the patient might have TB, but in reality you need more information than just what is present in that image. I would also need to know about your clinical history. We need to know what country you're in. I would need to know if you travelled somewhere recently where TB is very frequent. If you've been coughing and unfortunately the X-ray alone doesn't have all of that information in it. So if the question you ask your radiologists when they're labeling your training data is does this patient have tuberculosis will still try to answer it for you but will be answering a flawed question. Unless the data you're gathering is flawed. And what we found is a must we're building these tools. We can't structure it the right way to ask the correct questions. And unfortunately you don't realize you're asking the wrong question until very far down the line. And so that's why we wanted to make sure upfront that we're building with this kind of concept in mind.

What a great insight you've provided there Kevin. And oftentimes you don't realize this like you said until much later in the process. Can you share with us a time when you had a setback and what you've done and what you learned from that?

Yes actually the example I just gave is a good example of exactly that. The very first thing that we built was a fracture detector because..

Ah, OK.

One of the most common types of things that people come to the doctor with as far as a radiologist goes are fractures and then often in the extremities like a wrist fracture for example. So we built a model that could ingested an x-ray of the wrist towards the arm and would automatically circle a fracture in that scan if it found one. The intent being that when the radiologist brings the scan up it's a lot easier for them to find the fracture if a model already did it for them.

Right.

And when we collected the data for this the way that we tackle it, this was before we had all these systems we've built ourselves in place. We looked at what sort of image reading tools for radiologists exist today that are open source that we could mess around with and we chose one particular and set up a bunch of mac books for a radiologists to use. But all we did was load those x-rays of historic x-rays from our partners. And we asked the radiologists to circle the fractures and unfortunately that is not a very specific set of guidelines to give them. And so the data we got back even though you and I as non radiologists circled the fracture might seem pretty straightforward to them it could mean a lot offense. What do I do about the non wrist fractures. So the fractures that exist in the elbow or the fingers were somewhere else. Now what do I do about sesamoid bones which look like fractures and are often reported like them but are not fractures how tightly do I contour anything that I circle that was a big problem we and where when we trained the model the first time we found that it was getting all sorts of false positives and false negatives. So the first thing we did was we went back and we looked at the training data collected by each of the radiologists that participated in this exercise and we found that one person was just completely off the mark. They missed all sorts of fractures. And so we completely wiped them from the training data and we retrained the model and we find that that drastically improved results. And once we got rid of the bad actor things improved but we still had a big problem which was that the model in addition of getting the fractures correctly was circling all sorts of little artifacts that were not fractures they were just meaningless little blips. And again looking at the training data we realized it was because one of the radiologists who prepared training data did not know how tightly to contour them because we didn't tell them how tightly contour it. So he circled every fracture as tightly as humanly possible but a fracture just looks like a line. It looks like if you were to pluck a hair and put on a white piece of paper it's just that very thin line. If you zoom in on it enough anything looks like that any digital image when you zoom in enough looks like just a lot. And so having the model placed attention just that tightly on the fracture caused it to lose sight of the fact that the context around the fracture is what makes it a fracture. It's not just a line anywhere. It has to be aligned through otherwise healthy tissue. So what we did was we went back and we modified that training data to programmatically expands the size of each of these regions of interest they drew on the pictures by 30 percent and then retrained the model. And when we did that, we got amazing results. But the big thing that it really ingrained in us was this understanding that you have to be extremely specific when you're asking these questions where people are free to make up the rules on their own right. So now every time we launch one of these tasks it usually comes with about a hundred pages of these guidelines and several rounds of tests that we make them go through to begin with.

Wow, what a lesson learned and sounds like at this point for the chest imaging you guys have set some parameters very specific guidelines to ensure that you guys get more success upfront.

Yup absolutely. And that's been where a lot of the difficulty comes in.

My goodness. And it's a lot of work. You guys have to do all this stuff up front but at the very least you get what you need and and when you don't know what you're looking for you don't know what you're looking for right now. Now you do.

Yeah. No, actually it's hard enough that most of the time our task is finding any number of nondescript needles in a haystack. So we're learning more and more specifically about the problem.

It's a good way to put it. Kevin what would you say to date is one of your proudest medical leadership experiences?

You know I think it's hard to answer that specifically limited to medical leadership but I think it's been incredibly rewarding to see as the company progresses just that are the way that we vocalize our meticulousness about this data because of how ultimately this is how we ensure the best patient outcomes to see how well received that's been in this evolving market. There has been great and very rewarding because early on I think there were a lot of deceptive actors in this space that made a lot of very bold claims about what this technology could do and very quickly people realized that the promise is not there yet and it soured them toward the market and it's been very rewarding to see that with us being up there being very transparent about this being the voice of this is what we really can and cannot do in this space. How well that's been received I think that that's I say very rewarding because being in healthcare transparency is everything. And even though this is the intersection of technology and healthcare I think that's more true now than ever. And so it's amazing to see that other people agree with that message. And that that's something that's leading to success. But outside of that to sort of nail to some concrete moments, I think one thing that was very rewarding for us was last year doing a blind test. And this was something that I alluded to when speaking at TEDMED that we did a blind test mobile group radiologists that found that our lung cancer models weren't just picking up lung cancer but they were often discovering malignancies up to 18 months earlier than human radiologists were that this emergent insight came out of this approach to knowledge discovery and data integrity. I think really illustrates the true power of these types of solutions.

Wow that's really interesting 18 months prior?

Yeah.

That's amazing. Well congratulations Kevin. I mean no doubt that it's tough right. Because when you're in the market and you see the potential in a technology what it could do and then all of a sudden the bad apples will column come in and sort of muddy up the water. You guys have stayed consistent and you've stayed true to making this data as as clean as possible, working with the best parameters to get the results that you guys are looking for and you've gotten some wins so congratulations on that. And these results I mean 18 months beforehand. I mean that's huge.

Yeah and this is those are the main reasons that we pick lung cancer is an early thing you're working on. There were some abnormalities that it doesn't matter how early you pick it up. Unfortunately there's nothing we can do. But with lung cancer, the early you pick it up the more likely the patient is to survive. Then I think 18 months is quite significant. And so we really hope to see that be something that it's clinical practice if not this year or the next.

That's wonderful. And the other thing that you said Kevin that really struck a chord with me is the other factors. Right. You can't just rely on the image itself what's the context of this image? Today, I think there's a larger influence of the Social Determinants of Health and the influence that they have on specific diagnoses. And you talked about hey was this patient traveling or where did they live or what did they do. And these these things are now also included in the models that you guys are putting together?

Sometimes those factors are put into place sometimes they're not. It really depends on the specific problem that's being solved. But in the case of trying to build a general system for the diagnosis of chest x-rays just to limit the problem the one specific study time. I think it's critical to keep in mind that it's not enough. Just look at the picture. And if that's all you have then the answer you provide should take into account that that's the only information you have. In clinical practice. The hope is to use not just the report the image itself but any report that might exist about it. Any patient history that might exist part of the reason that we have that 18 month early detection is because of our use of longitudinal data. So the patients whose data train that model had several years of scans that the model has learned from and as well as a lot of demographic patient information and biopsy results and all sorts of other clinical data that has enabled us to extract those emergent insights then more and more so you'll see that become the common way that these systems are implemented where you'll have multiple models in tandem reading lots of different types of data and then they'll marry that output in the end in order to give you a much better representation of what we believe is going on.

Fascinating folks again just a reminder If you've tuned into this podcast a little bit later I've got Kevin Lyman here chief operating officer at analytic you could check them out at www.enlitic.com. They're doing some pretty amazing things. They're at the forefront of AI and in radiology. Check them out. Press rewind on this podcast because conversations have been really good. So tell us a little bit about an exciting project that you've been working on today?

Well all of it is very exciting. By the way I think you know one thing that is going down a wall unfortunately my way of boiling it down will be to expand that a little bit further back. I think one thing that's got us all extremely excited right now is we've had a lot of innovations around how to scale this process horizontally across the vast majority of digital diagnostics, as I said it's helpful to think of these systems as a black box that we can build a couple of specialized black boxes. But at that point the problem becomes around tuning it to all these different data sets that we collect so that it can work to a lot of different types of problems and that's really what we're focused on right now. How do we take something that does fracture detection and arrest or or lung cancer detection in the chest and now translate that to look for anything anywhere in the human body. And that's something that we're currently fundraising for right now. And as we close that round we'll be moving towards actually starting to act on that scale and I think that's really where we're going to see some of the biggest patient impact down the line because up to this point each of these solutions each type of study each specific problem you tackle has been a massive lead time in the development of those systems. Look at how long it's taken us to get where we are today or how long it's taken our competitors that many of whom are also doing good work to get where they are. But the exciting thing I think is as far as what we've recently come across is now greatly reducing that cycle to be pumping these systems out with very high quality for many different types of problems on a very short turnaround time.

Truly exciting and it's awesome that you guys are aiming toward this broader spread of these solutions across different applications. It's pretty exciting man. Congratulations on that.

Thank you.

So Kevin time does fly my friend. We could talk about this stuff all day but we do have limited time here on the podcast. We may have to do a part two but for now we're getting into this part of the podcast where we walk through set up a syllabus for the listeners. Since you mentioned earlier today sort of the importance of setting up the appropriate infrastructure for these types of innovations I love to take the focus of this course that we're going to put together for the listeners and the lightning round around that structure implementation idea. If you're good with it.

Yup.

Awesome. So we're going to call this the 101 of Kevin Lyman on setting up the infrastructure for innovation. And so as we go through this lightning round I've got four questions for you around this focus. And then we'll finish that up with the book that you recommend to the listeners and a podcast. You ready?

Perfect.

Awesome. So what's the best way to improve healthcare outcomes?

I think within the context of setting up infrastructure for any kind of administrator or leadership at the hospital I think it's important to re-evaluate the systems that are in place today. And I think we find from a lot of the partners we work with that they're still using systems from 10 plus years ago. And I know that all of these tools are very expensive to put in place and there's a lot of risk involved. But technology has progressed quite a bit in the past decade and I think it's really time to start updating some these tools to be more receptive to the incoming solutions from A.I. and other improvements and software that ultimately are going to lead to much better patient outcomes. But only if we set them up for that right now. And I would extend that by saying just a little bit but nothing is more important than patient safety. Then of course what stems from that is patient privacy. But anonymization is quite good today and so is the siloing of patient data. And while it might be very scary to give up patient data in this way I think the appropriate systems are in place these days that the risk is greatly reduced. And I think it's worth the risk, it's justified by the benefit that comes from sharing this information with the research community that can do amazing things with it.

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

Surely within this context of infrastructure I think getting to married to any one particular system can lead to big problems. I think we found with a lot of our partners that they put one system in place and it introduces problems. And rather than fixing the underlying problem they put more and more bandaids in place and so ultimately 10 years down the line when it is time to update that infrastructure. It's a massive amount of work in undoing all of these individual solutions that were put in place. If you come across a problem you solve the underlying problem.

Great message. How do you stay relevant as an organization despite constant change?

I think in our case we thrive on that change is where research organization but for a lot of these other groups that are sort of stuck in ways where it's a lot harder to adopt this change. I think it's important to listen to the research community and listen to evolving methods of how one measures risk in the field. I think the FDA is increasingly catching on to that and is growing more and more away from lots and lots of expensive clinical trials upfront and more and more toward what's pulling in the fields after doing a little bit of checking and then monitor it in the field to see how it does. And I think that this is a really powerful philosophy that in software development is pretty much what we call agile. But I think that hospitals in particular need to adopt this mentality a little bit more and understand that while there is risk involved in taking some of these leaps, you can minimize that and you'll get a lot better data by taking the leap and seeing how it goes. As long as you get the appropriate fixes in place.

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

Patient outcomes that should be the number one thing that drives every decision. And I know that a lot of times financial decisions are hard ones that need to be made in order to optimize for patient outcomes in the grand scheme of things. But ultimately that's the only reason that money should be the focus in mind. For all others it should always come back to patient outcomes and everything should always derive from that.

What a great syllabus here listeners. This is again directed toward the implementation of infrastructure to support new technologies. Kevin Lyman here from Enlitic. So Kevin what book would you recommend for the listeners?

My favorite book is the 80/20 principle. I think I've learned a lot both from the book and from the principal in and of itself that in many cases you can get 80 percent of the value with 20 percent of the work and that is in no way me condoning only doing 20 percent of the work in certain circumstances. But when you're in a very multidisciplinary field, the way that we are it's critically important to be very well educated not across just artificial intelligence and computer science and software engineering but also clinical science and medicine. Then the reality and gravity of the practice that you're trying to build solutions for and we're in a multi disciplinary field like that it's a very helpful mindset to understand that I will never be the best doctor in the world but if I'm smart about whom I spend my time with the people that are the best doctors in the world then I can learn enough of what they know to do good work in my field.

What a great message man.

I just want to make sure I also give a quick shout out for the tech intern blueprint. It's a book that was just written by two of my colleagues from the inventors guild or any software students or engineers out there that are graduating college and looking for a good tech internship. They've put together an incredible book full of Amazing Tips and tricks on how to optimize your chances of getting your dream job or your dream internship. So check in turn blue print. Check it out on Amazon.

That's awesome. Hey thanks for the recommendations Cavin listeners. Don't worry about writing any of that down. I know we've been talking about a lot of great things. Just go to outcomesrocket.health/enlitic that's E N L I T I C. outcomesrocket.health/enlitic. You're going to be able to find a transcript. All of the show notes and links to all the resources that our friend Kevin Lyman here has been sharing with us. This has been a ton of fun Kevin and I'd love if you could just share a closing thought. And then the best place for the listeners could follow up with or follow you.

Yeah absolutely. I think I always like to close these things just by telling people that they should be very excited about the future of health care because even though it's a field that from a technology standpoint hasn't seen a whole lot of rapid evolution, now is the time that really we're seeing more work done than ever. Well a lot of us would probably consider to be science fiction is actually creeping up on us a lot quicker than we could anticipate but in very good ways. And so it's something that I find very exciting and I hope to leave everybody very excited about this as well.

Thank you so much for that and Kevin what would you say the best place for the listeners to get in touch with or follow you as?

You can follow me on Twitter @ktlyman, or you could always e-mail me kevin@enlitic.com. I'm happy to answer any questions you have about clinical AI or anything of the sort.

Outstanding. Kevin this has been a blast really just want to acknowledge and congratulate you and your team for the hard work that you're doing and the advances that you guys are making. So just want to say thanks again for spending time with us. Looking forward to staying in touch.

Fantastic. Thank you so much for organizing it was really great chatting with you.

Thanks 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 could get together to 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 and be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book:

The 80/20 Principle: The Secret to Achieving More with Less

The Tech Intern Blueprint

Best Way to Contact Kevin:

Twitter: @ktlyman

LinkedIn: Kevin Lyman

Email: kevin@enlitic.com

Mentioned Link:

www.enlitic.com

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How AI and Data Analysis Can Improve Cancer Treatment with Dr. Andrew Norden, Chief Medical Officer at Cota Healthcare

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. We're chatting with some of the most successful leaders in healthcare today and I have a wonderful guest for you. His name is Dr. Andrew Norden. Andrew is a Neuro Oncologist and Physician Executive who joined Cota in 2017 as the Chief Medical Officer. Prior to joining Cota, Dr. Norden served as Deputy Chief Health Officer and lead physician for Oncology and Genomics at IBM Watson Health. Previously he worked at Dana Farber Cancer Institute in Boston in several capacities including Associate Chief Medical Officer and Medical Director of Satellites and Network Affiliates. Andrew served as Physician Leader for the Dana Farber community network for more than five years. He attended medical school at Yale School of Medicine before moving to Boston for residency training at Mass Genn and Brigham Women's hospitals. He's got a phenomenal track record in health and now he's serving at Cota as CMO. I'm so excited to welcome you, Andrew. Thanks for taking time to being on the podcast.

We'll thank you for having me, Saul.

It's a pleasure. Now is there anything in that intro that I left out that maybe you want the listeners to know about you.

Well frankly you covered almost everything. So I would say no, I think that was a great start and I appreciate it.

Awesome Absolutely. My pleasure. Now Andrew why did you decide to get into health care? Why the medical sector?

Well to be honest I never wanted to do anything other than healthcare from the time that I was a child. Now that said my initial thinking about that meant something much more traditional than where I've ended up in the sense that I thought I would be a physician taking care of patients my whole career. And I infected trained to do that and ultimately became a brain tumor specialist. I work at Dana Farber Cancer Institute in Boston for about ten years in a variety of roles some of which you mentioned and what I learned over time is that there are great rewards associated with taking care of patients. But the overall magnitude of the impact for me felt somewhat limited because of the way patient care involves one patient at a time and particularly in the area of cancer research and care that I was involved in brain tumors. The pace of progress was really slow so it was kind of with that lens that I began to look for ways to get involved in something that might have impact on a much broader scale. And I had always been really interested user of technology fairly sophisticated user of technology and had some opportunities to implement new technology systems in an administrative capacity I had leading Dana Farber's network. So I enjoyed that work a great deal. And when I had an opportunity to join industry and work for IBM Watson Health as a leader of their physician leader of their cancer care offerings I took that leap couple of years ago now and then ultimately made the move to Cota.

What a great journey and it sounds like you were very focused. You've always wanted to be part of this industry helping people but now you sort of took that next step and in your role now you're able to influence and even broader subset of people in a more agile way. Cotais doing some pretty impressive things maybe to level set the listeners on what Cota does. Andrew, I'd love if you could just give us the quick just understanding of what they do.

Yeah absolutely. I'll try to keep it as brief as I can. So Cota is a kids cancer focused data and analytics company and we were founded by a group of oncologists a number of years ago who serve that doctors were spending an awful lot of their time entering data into the EMR. I think most people in healthcare today can identify with that perspective that the EMR has become ubiquitous and yet despite the fact that we spend all of this time working on it we as physicians are often unable to answer the most basic questions that our patients ask us questions like how many patients like me have been treated before and what have been the outcomes associated with the decisions you've made in those patients. And people want to understand how do you Dr. Norden compare to other doctors and other centers. We can't answer those questions and that is really what Cota's primary goal is. We connect with provider organizations. We pull out data from their electronic medical records and from other clinical systems and then we present it back in a way that's useful and allows them to understand the way that they're treating patients and what are the impacts of the various decisions that their providers are making. Day to Day. We also have a really unique method of grouping patients almost like a digital barcode. We call it a CNA or a Cota Nodal address which is a novel way of grouping patients based on all the known clinically meaningful factors and patients who enter our system electronically or are assigned to this. This barcode this CNA which then enables one to compare groups of patients who are clinically similar between doctors insights and particularly when we marry that information up with outcomes data that we track clinical outcomes data and cost data. We can reveal a lot of useful insights that help our customers.

What a great explanation there Andrew and sort of offering the providers an opportunity to gain insights on a siloed data. Your guys are helping liquify that data bring it to them in a presentable form but also offering a precision medicine type of approach by matching these patients that have similar conditions and backgrounds with outcomes.

Exactly.

It's beautiful and you know what I've been having a lot of conversations about this and it's striking that the important things like measuring outcomes need to happen more so I'm really thrilled to hear that this is a focus for you guys.

Yeah. I mean you often hear the adage these days that you can't manage what you don't measure. And I think it's really quite true in healthcare measuring outcomes just hasn't been part of our routine work until recently. Our systems aren't optimized for doing that. That is definitely a major focus of Kodos efforts today outstanding.

Now we've already dove into several hot topics without even asking this but what would you say if you had to boil it down to one hot topic that needs to be on medical leaders agendas. What is that hot topic and how should they be approaching it?

Well at the risk of using a cliche I mean I think the answer is data data is an absolutely hot topic. We're drowning in it. There are systems that surround us. And you know if you ask a typical CIO of a healthcare organization how many systems he or she works with on a daily basis. How's meaningful data pertaining to patients. The number is huge and sometimes I've heard it said as high as a hundred or more systems. I think we all need to be thinking about an approach to make meaning out of this data. There are forward thinking health care organizations provider organizations and other types of health care organizations that are doing this in-house and others who are working with vendors like us to do it. But my general sense is that if you're not thinking about how you're going to use your data to your advantage at this point I think it's an important topic to jump onto as quickly as possible.

That's interesting and definitely spot on. Now give us an example how are you guys Andrew at Cota are creating results and improving outcomes by filtering and processing this data.

Yeah I'll do that for sure as I think about potential examples some of the ones that come to mind are things that are strikingly easy. If you have the right data at hand we work with a large hybrid or healthcare organization. It's sort of a community academic hybrid and also with a major local player in that centers region and one of the things that we have looked at as we've assigned the CNA that I described to patients this organization is patterns of variability and what we see in oncology are that there are two fundamental patterns of variability. One is that there is variability in the treatment decisions that physicians make for similar patients. So you take two patients who have the virtually same set of attributes and often you see a wide variety of treatment choices being made. And unfortunately in oncology oftentimes those variable treatment choices are in fact all acceptable according to local consensus guidelines which is to say that our consensus guidelines are quite broad and they leave the provider perhaps in many circumstances too much leeway to make a variety of different choices. The second and perhaps more surprising variability pattern that emerges is that when you take similar patients in whom their physicians have made the same treatment choice you still see a great deal of variability in cost and that's somewhat counter-intuitive because people often imagine that the treatment choice in oncology is the most critical driver of cost. But it turns out that it's only one piece. The other piece relates to all of the elements of care that surround the treatment choice. How often does the doctor see his or her patient. What types of scans the doctor order and how often are those scans done. What types of labs and how often are those lab done when the patient has radiation therapy which specific radiation technology is used. All of those different things have really meaningful impacts on cost and in some circumstances they may also impact important patient reported outcomes like quality of life. So that said we've been interested in delving into this issue of how patients who are similar clinically and are treated similarly still have differential costs and so one of the insights that we uncovered at the provider that I mentioned is that in a common scenario in breast cancer patients need to receive a drug that is called Adramycin which is potentially toxic to the heart. As a result when patients are going to go on this therapy they need to have baseline cardiac testing to ensure that the heart muscle is functioning properly. The reason being that if there is some baseline dysfunction then this would be a potentially dangerous drug for the patients to receive. There are two common tests that physicians order that are equally effective in assessing cardiac function. One is the echocardiogram and one is a nuclear medicine test called the Mugga scan. In this particular scenario that I'm describing it turns out that the mugger's scan costs hundreds of dollars more than the echocardiogram. So simply by looking at these patterns of care and cost impacts we uncovered that a set of physicians in this network were routinely ordering mogas scans getting no more meaningful information than the echocardiograms and contributing to hundreds of thousands of dollars of additional spend per year. So just by highlighting this for the system we were able to change practice and save money with frankly no resistance from the providers because they don't care at all which scans they use. It's simply a matter of what they're used to doing. All we had to do is let them know that is one test was more expensive than another and practices changed right away. And we have uncovered just countless examples like this where you can simply identify almost meaningless differences that are driven by habit and physician behavior more than by data or any evidence of superiority. And you can save a lot of money for the system at large.

Andrew so insightful what a great example. Very niche down to oncology very differentiated in the treatments that you're able to tease out for your provider listening to this. I'd definitely bet the light bulbs going off in opportunity right to reduce costs to offer more resources to these patients that need different treatments. So don't worry at the end of the podcast we'll get you a way to connect with Andrew and Coda but definitely continue the conversation and you know one of the things that I really love about the intel that you're sharing here Andrew is that it was derived by you and your partners which you guys are oncologists and in the grand scheme of sort of tech companies that come up in healthcare and you've got the tech focused people that think that hey since I built Uber I could solve healthcare problems. And then you have the providers that have the intel and are approaching this which is the category that you and your team fall into. And I think the insights that you're able to make come from those with knowledge and experience and insights that are going to be able to be useful in a faster way. So kudos to you and your team for bringing up these examples. It sort of reminds me my wife and I we were in Hawaii several years ago and it was February. We wanted to see the whales and we would just drive we would see no whales. Then we got into the boat and the whale watchers sort of taught us what to look for the water that comes out of the spout. The fin that hits the water all these things that we should be looking out for. And Andrew before you know I would see whales everywhere like I went from not seeing anything to there's whales everywhere. And when my wife and I got off of that boat and we drove up the mountain and we were driving back to the house that we rented. I swear to you from miles and miles away we saw whales everywhere.

Wow.

And it's because we were educated and here you are with your colleagues. You guys are on that boat and you guys are the experts and I'm sure that when you talk to provider executives you're like their whale watcher counterpart that helps them see these things.

Absolutely. And you know what's exciting for us is that the kind of information I just talked to you about comes from a data set that we build at a population level that maybe the chief of oncology or the administrative leader of oncology or the hospital leadership is looking at what we're really excited about at Cota is that we're now in the process of of offering Point of Care tools as well so that we can actually influence the way providers behave and the decisions they make at the point of care based on on these sorts of population level insights so we can bring it right past them at the time that they're making decisions.

Wow that is interesting and it sounds like you guys are making this to a more and more useful so so kudos for you guys. Now tell me this Andrew. You know it hasn't always been smooth. Can you tell us about a setback that you had and what you guys learned from that setback?

That's a very good question and I think I'm going to take it from the standpoint of this industry in general.

Absolutely.

And that is to say there has been a great deal of interest in encouraging providers to do the all right thing more often. And there have been a variety of different non technological and technological tools that people have built to help nudge decisions in the right direction. My sense is that in healthcare a lot of what we have done in the realm of clinical decision support particularly around treatment decisions relates to so-called clinical pathways or the idea that you can bring together a group of experts to make recommendations for how physicians should. Act in particular scenarios and then push those expert recommendations into the hands of frontline decision making staff to change their behavior. There's nothing wrong with that approach per se but you can imagine that there is a fair amount of pushback when oncology professional or any health care professional who's trained his or her whole life to be able to make a particular set of decisions is told. You're now going to follow this particular expert guidance. So our approach is distinct from that in that we bring actual historical data to the fore in a way that makes it really objective and non-threatening. When you're a physician and I show you data that says the last 10 times you saw a patient like this and you gave treatment X and your colleague did saw very similar set of patients and chose treatment. Why. But in the case of that colleague the patients had invariably fewer side effects and the cost to the system was less. It makes providers think twice in a way that I think they're much less likely to if you say here's how you have to do it going forward. So we are taking that approach of presenting objective data that's straightforward and easy to understand. And what we find is that physicians actually appreciate the opportunity to see the impact of their decisions in ways that they haven't been able to before rather than taking the approach of sort of telling them what to do.

Now that's so interesting Andrew and you know the other thing too to call out here is is that when it comes from a peer it's that much more well received. And they think that one of the things that differentiates your company from others out there is that it's peers right. You guys are oncologists and you're offering credibility. And with that they open up their ears and they listen.

Yeah I think that that's really true in a lot of ways I think about it also that data is the language of science and medicine and expert consensus is valuable but it's not as powerful and it's certainly more emotion laden and sometimes controversial. So that's our philosophical frame.

Yeah I think it's great. I mean it beats somebody from Google Sean up that knows nothing about oncology telling them what to do.

Well no question no question about that although we all know that our colleagues at Google have been doing some smart interesting things in healthcare in months and years as well.

Without a doubt. But you know you know I'm just saying that to make a point.

Well taken.

That for sure Andrew. So tell me what's one of your proudest medical leadership experiences debate.

Well I think unique in that I've had a variety of different careers in healthcare. I had a career as a clinician and clinical trial list and then a career as a hospital administrator and now a career in health I.T. and I could probably answer this question in a different way for each of those. But maybe what I would say is that in my current world where I work with certainly a number of folks with oncology experience but also a huge number of folks who don't have oncology experience people who come from the technology world or the business world or fresh out of school or data science biostatistics. All of these are key disciplines that bring a lot to what we do. But for me what has been most gratifying is really helping our team at Cota to understand just how valuable data and simple visualization and analysis can be in healthcare. I think everyone would agree that healthcare is behind many other industries in terms of the way we use information technology day to day. We still are faxing records between provider organizations on a daily basis. We have limited ability to see population level analytics. All of these sorts of things. If you want to have if you show up in an emergency room the odds that the provider there has access to your recent test results remain really really low. So I've spent a lot of time at škoda educating our team about how even things that seem technologically unsophisticated can in fact make major major impacts. And so for us simply organizing the data and bringing it to the fore at the right time is so powerful. And I have found it really gratifying just to be able to show our team how that matters and how by doing that we can actually help to ensure that patients are getting the right care or not having duplicated tests or the unnecessary treatments provided and the like. So that is probably where my pride is the chief medical officer Cota comes from today.

Andrew you brought up such a great point on this point that he didn't have to be technologically amazing. It's the simple fact that if you find a way to implement it you just find a way to implement whatever is out there and in a useful way that's what makes a difference. I teamed up with the Center for Health and innovation and implementation sciences at Indiana University's School of Medicine. We're putting together a conference. It's called the healthcare thinkathon. And our theme is innovation is implementation and health care.

I love it.

You don't have to keep coming up with new things. And your point here is it folks if you're curious about that Scott outcomesrocket.health/conference you'll find more details about that there. But yeah Andrew I love this point you're talking about something real here is that it doesn't have to be complex, it has to be useful. Exactly. Most powerful man. So that's exciting now. Now take us down the path of something exciting that you're working on a project or a focus that you guys are working on at Cota today. What's lighting your fire today?

Oh sure I will. We have spent most of this conversation today talking about what we do that helps providers and patients and of course providers and patients are absolutely at the forefront of what we do Cota and in the healthcare industry in general. One of the really exciting things that we're working on right now relates to the pharmaceutical industry and the drug development process. I think all of your listeners will agree that drug development takes too long and is too costly today and there is universal agreement that anything we can do to get effective drugs into the hands of providers to prescribe them and patients to receive them is warranted. That's one of the things that we're working on at Cota is called the concept of synthetic control arms. You may know that as a drug is developed when it's promising it often needs to be tested in a randomized Phase 3 trial before the FDA or other regulatory agencies will approve the drug for use in people on a routine basis. And we also know that an unexpectedly large proportion of drugs fail in phase 3. So that is to say that perhaps they've been tested in comparison to historical controls in a Phase 2 study and the results look promising. So they go into Phase 3 where the drug is then compared against the existing standard of care or against the placebo and oftentimes after years and billions of dollars spent in Phase 3 we learned that in fact the drug is not more effective than placebo or not more effective than the standard therapy and drug development is abandoned. We think that there's a great opportunity to change that reality by providing a contemporary high quality synthetic control arm in Phase 2 and I think it's important to understand what often happens in Phase 2 studies is that the comparison group is a historical control group that may have been reported 5 10 even 20 years ago and the details of which may not be well published are well known at present. So we are working with a variety of healthcare stakeholders and agencies to develop a synthetic control arm concept in which we could statistically compare a drug in a small phase 2 study to a synthetic control arm created of for example historical patients in Cota's real world data set so that if the drug still appears promising after Phase 2 it's much much more likely to succeed in Phase 3 and ultimately be approved. Alternatively if it looks unlikely to be more effective than a synthetic controlled arm then drug development can be stopped at that point averting the need for additional years of Phase 3 patient enrollment and again billions of dollars spent. So this is a work in progress that a variety of different entities including us continue to work on but I think that the potential to really help speed up and make more cost efficient the drug development process. I think that's really exciting and is going to be real.

There's no doubt you guys are focused on improving outcomes and cutting costs and I think it's all being done in a very thoughtful way. Andrew so thanks for sharing that listeners if any of this is resonating with you. I encourage you to check out Cota on a deeper level. Go to www.cotahealthcare.com and you'll be able to find out their solutions are technology more about the company and their hiring too. So if this seems like, right you're telling me at the beginning of the before we started recording folks. They're hiring engineers they're hiring medical directors, they're hiring delivery and human resources so check out Cota as a workplace. But also if you're a provider check them out to see what they're offering because I think you'll be very intrigued and pleased to know that they may have something for you and help you and what you're working on today. So this has been fun. We're getting close to the end here. So I've got this medical leadership course you and I are going to build. It's what it takes to be successful in health care the 101 of Dr. Andrew Norden. So we've got four questions. Lightning round style followed by a book and a podcast that you recommend to the listeners. You ready.

OK.

Here we go. Lightning round. What is the best way to improve health care outcomes?

I would say measure what matters and use data intelligently.

What is the biggest mistake or pitfall to avoid?

Remember that hype and results are not the same thing. And it's important to ensure that you're able to do what you say you can do before you go out into the world and start announcing it.

Love that. How do you stay relevant as an organization despite constant change?

I think the answer there is you need to focus. You need to pick one problem to solve and make sure you can solve it better than anybody else out there.

I love that Andrew one of my favorite acronyms as focus. Follow one course until success.

I like that too.

What's one area of focus that drives everything in a health care organization?

Well I'll tell you in our company it's about having a high quality data set and being sure that it's collected in a way that that means it's real.

Beautiful. What book and what podcasts would you recommend to the listeners on the syllabus.

So my favorite book not about health care at all but has been meaningful to me throughout my professional life is the Dale Carnegie book. I suspect many of your listeners are familiar with it How to Win Friends and Influence People.

Yes a great book. What a great one. And folks listen. One of Andrew's favorite books being Dale Carnegie's. Then surprise me why he's done the amazing things that he's done and has had the career shifts that he has had. So if you haven't checked that one now be sure to check it out. How about a podcast?

I'll tell you I also have really been enjoying the A16Z podcast put out by the Silicon Valley VC firm Andreessen Horowitz they talk about technology and healthcare entrepreneurship and I find all sorts of tidbits of wisdom in there when I listen.

What a great recommendation listeners. All the things that we discussed today the podcast that he recommended, the book, and all of the show notes and transcripts as well as a link to the company. All of that could be found at outcomesrocket.health/cota so visit that and check out all the links there and resources. But before we conclude I'd love if you could just share a closing thought Andrew. And then the best place for the listeners could get in touch or follow you.

Yes you bet. So as we close you know I would say that a key to the next step in health care data and analytics is going to be around how we capture high quality data in the course of our daily work. I think Cota and others like us are beginning to do a really nice job of trying to make meaning of the data that exists in the EMR. But wouldn't it be nice if the EMR were constructed in a way that the data that flowed freely from it was high quality and helpful from the get go. I think that's going to be the next frontier for this work. I would be delighted to hear from your listeners. I'm at andrew@cotahealthcare.com. I think he spelled it out before but cota.healthcare.com and it's just andrew@cotahealthcare.com.

Outstanding Andrew. What a great close there that you left us with that aspirational EMR I think is a destination that we're all going to enjoy getting to. And with the efforts that you and your colleagues over at Cota I know it'll probably make it faster so just want to appreciate all that you've done for us today and sharing your thoughts. And we're looking forward to staying in touch.

Thanks a million. I enjoyed it

Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talk 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 to 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:

How to Win Friends and Influence People

A16Z podcast

Best Way to Contact Andrew:

andrew@cotahealthcare.com

Mentioned Link:

www.cotahealthcare.com

Episode Sponsor:

Improving Healthcare Quality and Outcomes by Focusing on Human Factors with Sameer Badlani, CHIO & VP at Sutter 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 have a wonderful guest for you today. His name is Dr. Sameer Badlani. He's the chief health information officer and vice president at Sutter Health in Sacramento California. Dr. Badlani comes to us with a lot of experience in medical information as a chief medical information officer previously at Intermountain Healthcare. Then prior to that, the chief medical information officer at University of Chicago preceded by a wealth of experience as a physician and also just a biomedical informatics expert. So I really want to extend a warm welcome to Badlani and also just open up the microphone to use some ear to fill in any of the gaps in the intro that I missed. Welcome to the podcast.

Thank you Saul. I really excited to be part of the conversation and all the nice things you said about me. Thank you for that. I guess the only other thing I would add is that I used to practice and teach practice medicine and teach clinical medicine at the University of Chicago, was the faculty inSchool of Medicine and the wonderful opportunity to teach medical students an internal medicine residents and that's definitely one thing I miss of my current career.

Say you had a great great opportunity to be at the frontlines and train future physicians and now in a leadership role at Sutter. I always like to go back to the very beginning. Sameer what got you into the medical field to begin with?

Well true story at the age of four years, my mother brainwashed me and said you had to become a doctor so here I am. Nothing chattering about anything significant which is just good old parental pressure.

And hey you know you listen then. Good thing you listen. Because things are going pretty well.

Yeah. So I've enjoyed you know all jokes apart. You know that's how it probably started. I progressed through my high school. It was something that you know I found myself really looking forward to the opportunity of joining a medical school. And when it all happened I realized you know this is exactly the career I wanted and in many ways even though I don't actively practice anymore except on friends and family what I do allows me to benefit patients and clinicians have a much larger scale than I would have been able to if I was just being a panel of patients. As far as I'm concerned you know I'm still a doctor. I use different skills to help deliver better health care.

Definitely on a broader scale and and in today's day with technology being so pivotal to the things that we do. Your skill set is definitely very very uniquely poised for some broad impact in that field. Sameer what do you think a hot topic that needs to be on our listeners agenda today and how are you guys approaching it?

Sure. I think the hottest topic these days is generally under the broad purview of the transition from fee for service to value based care. The way I like to break it down is most people end up getting embroiled in provider peer payment set up that's how they see these two opportunities. As far as I'm concerned the way I like to look at it and a lot of my colleagues do as well is that health care costs a lot more in comparison to the value we provide and the value and outcomes I would choose to value plus outcomes. And the reason we say that is that you know if healthcare was costing what it cost today in the United States and then everybody in United States are a significant population was satisfied with their health care experience and outcome and we were the healthiest country in the world then I would say you know money well spent. Keep on going. But that's not the case. While we are number one in I think I may not be far off on the statistics but number one in the percentage of our gross domestic product we spend on health care and the actual dollars you spent on health care. And then when you compare from any w8 or other metrics used out there to compare the health of different countries are probably somewhere in the low 20s high 20s or low 30s that's where we were last time I checked. So we're clearly not getting Money's worth. You wouldn't go to a car dealership and say I'm willing to pay a bill for the highest price car and I won't care if that's the 30th in quality. So think of it that way. And for me that's a very hot topic and every medical leaders agenda is how to do more with less. How to do better than we have done in the past and how do we engage our clinical workforce and our patients differently in this digital age.

I think that's such a great analogy Sameer. Nobody would want to pay triple for a car and you know hit me 30th on the list of great cars. Can you dive into some examples of things that you've seen or things that you guys are doing over at Sutter to bridge the gap.

Sure I think I'll speak. One example is on the quality side there are a lot of quality metrics that an organization like Sutter and any of our peers large or small are different ambulatory and patient and so on used to measure their clinical outcome. While the current quality metrics are not ideal in the sense they are more of process metrics rather than outcome metrics. It is what we have today and I'm very proud to say that Sutter does really well in these metrics. One of our goals about 2-3 years ago was to really provide that level of quality at all of our site. So one of the collaboration projects that we launched internally within Sutter was a partnership with my department which is informatics and analytics along with a quality department where we built an analytic dashboard that allows us to not only measure in real time the quality, the experience of operation but how are we progressing at all our sites, all our physicians and while I would be misplaced to say that has made singularly made the difference to have definitely for sure contributed to our ability to pull the right leavers have the right conversations assign the right resources where this analytic dashboard and the associated informatics workflow and the business workflow. Last year we had a much higher result than ever before for the quality that we provide to our patients. And that's deeply satisfying because while it's been a tough project, it took good three years to make it happen. Lots of money, lots of time. It is delivering the results that we hoped for and more importantly these are meaningful results. It's not a fancy machine learning dashboard that I can just give a talk about.

Sure, sure, I know I think that's really really neat and you bring out machine learning and sort of it being fancy at the end where the rubber meets the road is where it matters most. And so congratulations to you and your team for creating this summer. What would you say in that solution that you guys put together. Was the secret sauce. Why do you think it was successful?

A few reasons. I think number one we had a clear idea of what we want to change. So the business case was crystal clear in our mind set up various quality and value based measures that we wanted to improve our performance by not only being able to measure what it is in real time rather than finding out three months later what happened but also to be able to help in the day to day workflow for quality managers in impacting that workflow and working with our patients. It's by no means a completed project it's a good start.

Sure.

I would qualify it, that was the first point the second thing was a really good and intense collaboration often full of friction but still good and focused on the right objectives between my teams and the quality and operational team. And I think that's what you need. Often people describe good collaboration is where nobody fights with each other. I would say those are the worst kind of collaborations because you never find out what's wrong. Still it's too late but in this case I think the healthy amount of objectivity and interpersonal challenging that was going on allowed us to arrive at a better product. It's definitely I think going to be a prototype for us for future success. The most difficult part which I would say somewhat surprise me but shouldn't have surprised me in hindsight is how difficult it was to get a standardized workflow.

Once the analytics dashboard had made and if there is of many I hope helpful or else that we will be able to share today one of them definitely has to be focused less on the technology or the completeness of the dashboard or cause a lot more on the standard work that your team will do once that analytical site is available. What we found again not to our surprise is that different people in different parts of the company probably under the same job code were doing their jobs very differently and that's what we find in almost anything we do. So probably the last one year has been less about fixing the product or refining the product it's been more about standardizing the workflow amongst various individuals in a team that's spread across the entire geography of Sutter Health and the complexity that comes with it and then changing the system accordingly. And I think that's part are building us I.T. solution which is definitely in the realm of informatics ethnography is very important because you standardize the job to be done then all level of solution work in supporting it.

Such an astute observation. And we really thank you for sharing that Sameer. And yeah you know when you have the clinical variability there's no machine, no algorithm that you could place on top of it to make it better.

Right. And this applies to clinical variability or operational variability. I think you have had a very insightful. I would say nerve there because many people look at the healthcare system as a single clinical workflow a patient meeting a doctor or a patient interacting with a nurse or the billing department. What we fail to realize often while being in healthcare is that there is an entire back office in a middle office that is not dissimilar to any other business industry vertical out there like retail banking or finance marketing. Any of those. So that's where we have a lot of opportunities to standardize our processes, reduce the waste while continuously trying to deliver better health care.

A great call out Sameer. And super fascinating that the last year, you worked on a tool the first two years now last year is all about workflow standardization. And now you guys are having some big strides in the results you're getting. Can you give the listeners an example of the results you've created by doing things a little bit differently?

Sure. So you know for example we are measured on have we done all the appropriate preventive care for our patients. It's not only a measure of the quality of care we provide. It also allows us to improve the health of our population that we serve, the consumers that we are. And one of the places where this has helped us is that we know the gaps in clinical care very early in the year rather than finding out much later as I talked about so very, there's a difference between in real time and dynamic. And in this case I will say it's a dynamic report which based on all the available information we're able to tell you that these are the 10 patients in our panel who are missing diabetes check or are missing Cancer Prevention check. While we are still working on enabling the workflow now that we have the insight we are now much more of there are gaps and can we go after these 10-15 patients to get them into the health system in some shape or manner and get them the preventive care they need. And as you know prevention is a way better off taking care of a population than treating acute problems. This has made a big difference. The other thing is we are able to document better as to the care we have provided and that reduces redundant care. You know if the record does not show properly or the inside doesn't show properly that I have required blood tests for diabetes I may end up getting the same thing prescribed to me by another doctor so that's unnecessary testing, unnecessary cost and unnecessary pain from a blood test and unnecessarily waste of my own time. But I have to you know figure out how to make it to the lab and get test done. One of the biggest complaints our patients have is why don't you have all my data in one place when I come to you. So this helped us prevent a lot of those gaps in care that we had gaps in communication that we had.

No doubt some serious results here Sameer. As we walk through this theme of value based care. How are you looking at for example patient reported data to help with that?

So a great topic to talk a little bit about patient reported data and the broad category. It needs to be differentiated in outcomes that are reported by a patient. For example you came to my clinic and I did a new procedure on you. So you send it information at one week at one month and six months. How good is your walking. How good is the swelling, or hopefully gone by one month. And how is your being which was the first reason you first came to me. And so those are patient reported outcomes which is what we should be really focusing on. Was this patient generated data which has a life of its own now that the Fitbit, Apple Watch and every other device out there that is able to measure and sent the information. What I'm not saying is that it's not imortant, what I am saying is that it has caused an unfortunate amount of hype whereas the mere availability of raw data is being seen as a breakthrough. And I would humbly beg to differ. A physician right now, a nurse right now is already overburdened by a large amount of raw data.

Yes.

And what they need to be doing are again not even dashboards. As a physician, what I would like to see is that if I am your specialist helping you take care of diabetes, instead of knowing all the raw data you collect on your glucometer, I want to know how many times, was your insulin not enough. How many times. Or is it too much. And how are you generally doing on your diet. And then even moving to the next step what basic adjustment can be done to your insulin and diet without getting me involved. When I get involved it should be for cases where we really need to have a deep discussion. The goal of any of these analytic data and informatics platform should be only one at the end of the day to allow a patient and a physician to spend more time with each other in a meaningful way so that a better healthcare outcomes can be achieved. If all these tools all these fancy technologies lead to distraction like they normally do or they lead to more data overload causing cognitive dissonance. We are only making the problem worse. So I like solutions that would use the data aggregation while factor into aggregated all the patients data. They told me how they were support patient generated and patient reported. And based on that we took six steps to take care of a patient that was decided in a protocol that you are nurse in your hospital and your clinic. And here is how he or she is doing or you know what you did pre decided six steps and it still not making a difference. We would like to bring in the patient to see you. That's how I would like to see patient generated and patient reported data being used. I think we got too excited at the fact that I could even get access to that data. We forgot why we were doing it in the first place.

That's such a great distinction to make Sameer and I thank you for that. Because yeah you know it is happening and you look at companies gathering this data and you know the excitement can sometimes cloud judgment and the metrics that we're after the outcomes that we're after. How do you maintain clarity amidst this excitement. What advice would you give to health leaders in the trenches?

It's very hard. So I would be completely lying if I said I don't get drawn into it or I don't find it exciting because we are all trying to make a difference here. It is hard but I think it is the most necessary task of health IT leader today is to not let the shiny technology in front of us obscure the importance of the patient and the physician that we are trying to serve here. I make sure to add the physician because with the last few years while we have had a very healthy much needed focus on patient engagement, a lot of it has come at the cost of clinician engagement, both physicians and nurses and advanced nurse practitioners and physician assistants which has led to a significant amount of dissonance job dissatisfaction and burnout that we hear a lot about. So it's really important that when you are thinking of a solution, you really want the patient and the physician and the clinical workforce as your primary client and then the clinical outcome as your use case focus. So that's number one. I think that helps us really keep our focus. Number two is is the solution to improving outcomes and at the same time reduce the cost of care delivery or maintain the cost? I think for too long, if something short or even mere chance of improving a clinical outcome, but was extremely expensive from a total cost of ownership model we were not worried about it. You know we would say the ROI would take care of it. I think we need to stop doing that. Health care needs to be run like a true PNL business which will allow us to have a robust focus on how we think of the solution. You have to really hold ourselves accountable to go back and check on how well did we do on various metrics of improving clinical care reducing the cost of care and improving the access for our patients and improving the job satisfaction for our physicians. Those are metrics that you need to hold ourselves accountable to.

Some great advice there Sameer. Friends if you're listening. You probably pulled over to take some notes. You didn't, the nice thing about podcast is that you could always rewind and go back because Sameer definitely offered a lot of value there. I encourage you to go back. Listen to this again and start thinking about how you could approach this subject of new technologies and keep that outcome at the center of all your decisions. Sameer, I feel like oftentimes we learn more from our setbacks than our successes. Can you share with the listeners a setback and what you learned from it?

Oh boy. So many to choose from. And I think you're absolutely right. I only learn when I make a mistake because when something goes well you assume it's because of what you did but you have no data to prove that. It's only when you fail do you potentially have the opportunity to do a root cause analysis and you learn. I think you know rather than focusing on the one time I failed because there are so many honestly I think it's one area that I know I have failed in the past for sure is not thinking enough about change management. You know it's very easy for me to say I picked the wrong technology, I picked the wrong stack and that's why something failed. I would again encourage our users and colleagues to think differently. It's often in the change management that we feel. And what I mean by that is if you look at the Design Theory or the design methodology the first step in that is have empathy for the user and make it stop right there is that have you really understood the change you will make to the user's workflow and how it will impact the job to be done as they think their job is and these are words taken from professor Clayton Christiansen who wrote the book in which his dilemma is an example of the many good books he has written is really important. We do not take a pause to understand how will this change the job that's being done by a particular group of people where this technology or this new process or this new clinic will be implemented and then do they have enough training backup support and continued support to make a difference in the informatics world. There is a common joke that if you go up to the senior management person and say hey I need 20 million dollars because our servers are end of life systems will come down we will get you know maybe 30 million dollars so make sure it doesn't happen again. If you go back and say hey you know I want five million dollars to retrain all my nurses and physicians and standardize workflow. You'll get blank stares though somehow from a very tangible request you went into the intangible in the minds of many people. I think that's a mistake that I have been guilty of making is to not ask for enough resources in that space, not spending enough time thinking through the what ifs in those in that arena. So I think human behavior and human change management are probably the places where I always feel have I done enough. So in many ways I feel like psychology of change is the most powerful technology we have access to and we don't use.

Sameer you bring up some really great points and again you know hitting on this theme of ensuring that we've got the right clinical flows, we've got the appropriate level of attention on ensuring that these workflows are in a good place. I love that you're focused on this despite the fact that you're very tech-centered, you still continue to bring us back to what matters which is the quality of these providers as well as the quality of the patients. And in your experience, what would you say one of proudest moments you've experienced?

Right in discourse or fuselage when should I talk about? I think the first distinction I would make is that you know I definitely see myself as a medical executive or a healthcare executive. I don't see myself as an IT executive. I am a clinician first and last and I just happened to use health I.T. as most outwardly visible to get to make a difference. I think the most proudest moment probably came from a teacher mindset is where I've had two or three really misguided people say they want to go down the career path I have. So I try very hard to convince them otherwise. But I think that was a big compliment to be able to see the kind of results that from my teacher mindset. And then the other one was you know way back at University of Chicago where I was there Chief Medical Information Officer five six years ago and we had we are still finishing up our big implementation and I had a couple of nurses come up to me and say that some of the recent changes in workflow and technical fixes that we had made allow them to delay they safer care in the OBGYN and department. And you know for many reasons that really resonated. I've had many other such experiences. But if you think about it, the little babies are probably the most vulnerable population. There is plenty of chances to make mistakes. And that was around the time that my daughter was also born. So maybe the hormonal overload for me at that time was kicking in but I think that was one of my proudest moments and reinforced for me that a personal sacrifice. I feel like I'm making every day by not practicing actively does amount to something of material difference to the patients and physicians. I serve.

That's wonderful. No doubt, Sameer, children's definitely one of the best in the world and pretty awesome that you did that work over there Sameer, you know in my backyard I'm here in Chicago. We definitely recognize the University of Chicago is definitely one of the best in the world. So kudos to you and your team my friend.

Thank you, thank you. IT was a team effort for sure. But like I said it validated my career choices.

That's wonderful. Tell us about an exciting project or focus that you're working on today?

It hasn't kicked out but I'm really excited to talk about it. So building on the team or the biggest technology we have access to is the psychology of picking the mind and change management. If you extend that formalized that it gets into the field of behavioral economics or behavioral psychology and it's employed by marketing sales pharmaceuticals for decades in fact it's a well known secret that the biggest recruiter of news psychology grads are sales marketing and pharmaceutical industries. And it makes complete sense. So for me I think in healthcare, we are so focused on new technologies new diagnostic methods, more doctors, more hospitals, more nurses that we have completely missed out on the opportunity to change human behavior. In this case the human is either your employee,your collaborator as a physician or a nurse. And then finally you convene which is your patient to influence their behavior. So this is also known as the nudge theory. And there are many books written about it where they talk about how you raise a certain question or how you present a certain situation. People react differently. Very good person example that I like to share that when I was applying for my license in Chicago. And in fact that day my clinical practice was focused on Crohn's con medicine just the inpatient medicine not for surgery. And I go to fill inmy get my driver's license after having moved from a different state. And one of the questions is do you want to donate your organs when you die? It was something literally as put a life and I have to admit at that moment I stopped being a transplant physician who fret about the availability of organs and I became a mere mortal. We're like no. I changed later. Right now I don't feel like clicking guess. You know I became this illogical irrational human being where I thought the mirror checking off a checkbox on the form would and dice mortality on myself and I have never really gotten over what I consider poor choice by me almost ten years ago of answering that question now. Many other state that I don't know if anyone has changed. Do it differently. Instead of making it an opt in where you have to rationalize your eventual mortality, they talk about opt out where instead of saying you know do you want to when you die. You say when you're no longer in the world do you want to not help your fellow human beings. So then it, number one makes it an opt out. The decision is sort of be made for you and then number two it appeals to your altruistic side and you're like oh I want to help. I'm a nice person. I help my neighbor with their garbage when they gone. So yeah I'm a nice person. Of course I want to continue helping people. So the response from the same person becomes very different. It has been applied for example by the United Kingdom Tax Department. Where of saying you have to pay your taxes on time otherwise you have just been told that there will be people just throw that mailer in the dustbin. Instead they leverage one of these professors who was expert in the nudge theory and he guided them to send a simple postcard that said Did you know that by X date 72 percent of your neighbors have already filled in their taxes. They are like what. I'm the outlier. I'm the bad person in this neighborhood and you know start behaving different. These are just a very simple 20 cents Coast Guard made a difference of about 10 per cent a multimillion dollar revenue opportunity for the tax department. So in healthcare we need to bring a lot more of that and there isn't enough of that. I see or least are for that. And you get banned. We are working to figure that out at Sutter ourselves and the amount of time that we spend on the computer delivering health care. The amount of time our patients spend on the computer are not only receiving their healthcare but into the digital world offers tremendous opportunity for us to take advantage and do some real good here. So that's the area that I'm really excited about. I'm trying to figure out what would be my first proof of concept and how to get them going. Hopefully at a future date I can talk about that as one of our good learnings.

That is super exciting and it's definitely full circle just getting back to that psychology Sameer. And you know what, anything you get involved with. I'm interested in following so please get you back on and maybe a year or so when you get it off the ground to to hear about how things are going.

Thank you. I would love that.

Awesome. Sameer, we're getting close to the end here so this part of the podcast a quick lightning round for questions. We're going to build a medical leadership course on what it takes to be successful in medicine. The 101 of Dr. Sameer Badlani and so I've got a syllabus, four questions I'll ask you does and all finalize it with a book that you recommend to the listeners. You'r ready?

Absolutely.

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

Stop wasting money.

I love that. What's the biggest mistake or pitfall to avoid?

To view you have all the answers or what worked the last time with work this time too.

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

I think singular focus on delivering value for your consumers and in a health care organization that's just not your patients goals or your prayers. And it's also your provider partners so all three.

What's one area of focus that should drive everything in the organization?

Delivering better quality care to our patients and running it like a true business.

Well said and finally.. Yeah that's perfect. What book would you recommend for the listeners as part of the syllabus?

Sure. So you know I'm a big fan of the classic literature so pick any book from Shakespeare. I think you will find a lot of life lessons and in healthcare I think it's comedy of errors is probably the one to start with.

Wonderful what a great recommendation Sameer. Thank you for that. Listeners, don't worry about writing any of that down. Just go to outcomesrocket.health/badlani as in Dr. Sameer Badlani and you're going to find all the show notes, a transcript of what we've discussed as well as links for the organization that Sameer with and all the things that we discussed as well as a link to the book. Sameer, this has been so much fun. Really appreciate the time you've spent with us if you can just leave us with a closing thought. And then the best place for the listeners could get in touch with or follow you.

Sure. With all postal vote thank you for this opportunity was really interesting for me to go through the process and share some of my thoughts. I feel very lucky and hopefully other people find it entertaining and interesting. I think LinkedIn is the best to get hold of me. It's the easiest social channel, I'm not on Facebook and occasionally show up on Twitter who talk about coffee. So LinkedIn is probably the best place. I think one closing thought I would have is have a very clear idea of what is the outcome you're trying to achieve in your day to day work. Too often, we spend time delivering projects and not outcomes. And I think that's a fundamental change that needs to come into how we deliver health care.

A great message Sameer. Listeners, hope you enjoyed this as much as I did and again be sure to rewind and listen again because Sameer definitely offered some great takeaways that you can apply your organization. So Sameer, again just want to say big thank you for spending time with us and looking forward to having you back.

Thank you so much. Have a good day.

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 Comedy of Errors

Best Way to Contact Sameer:

Sameer Badlani

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