Newsday - Leveraging Tech to Care for Patients, Staff, and Under Reached Populations
Episode 38912th April 2021 • This Week Health: Conference • This Week Health
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 Welcome to this Week in Health It, it's Newsday. My name is Bill Russell, former healthcare CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping Health IT staff current and engaged. Special thanks to Sirius Healthcare Health Lyrics and Worldwide Technology, who are our new state show sponsors for investing in our mission to develop the next generation of health IT leaders.

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So it's really digestible. This is a great way for you to stay current. It's a great way for your team to stay current. In fact, if I were ACIO today, uh, I would have all my staff listening to today in health it so we could discuss it, you know, agree with the content, disagree with the content. It is still a great way to get the conversation started, so check that out as well.

Common question I get is how do we determine who comes on this week in health it, to be honest, it started organically, it was just me inviting my peer network and after each show I'd ask them, is there anyone else I should talk to? And then the group, obviously the network group, larger and larger, and it helped us to expand our community of thought leaders and practitioners who could just share their, their wisdom and and expertise with the community.

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Now onto today's show. Alright, today we have a lot of topics to cover and, uh, not that many stories, but a lot of topics and so I welcome Anne Weer and welcome back to the show. Sorry, just about to take a sip of coffee as you're welcoming me. Thank you. Sorry, was a, it was a short welcome. Yeah. . I thought were gonna more topics.

You know, it's, it's interesting. Each one of the guests that I have, recurring guests I have back on the, the news show has a different perspective. And your perspective is one where I like to go in a lot of different directions. Your perspective is as a former founder for a a health tech startup. And you sold that startup.

And there, there's just a lot of stuff going on these days. I mean, transparent and, and those guys have, have, have come forward and, and that's exciting. You, you have a story, several stories that you're gonna share, which I think lead us into a different, uh, direction. And I have, I have one story. It.

I read the annual report from JP Morgan Chase, and this is where I'd love to start because it had so many good things in here for, from the, from the founder. From not the founder, gosh, the founder that would, founder of JP Morgan would be JP Morgan, but Jamie Diamond, the The CEO. Yeah. He. He had a lot of good stuff to say and I, I think it gives us a lot of, uh, a lot of different topics we can jump off on.

Uh, did you get a chance to, to, to read this? I skimmed it. I was actually kind of hoping that you would. Oh, that's great. You know why? That's great, because I skimmed the articles that you sent me. The audience hasn't read it either.

I hope you're gonna lead me through 'em. I'm gonna lead you through this one a little bit. So, you know, Jamie Diamond is one of those people when he talks, the world's world listens. He's one of maybe two or three annual reports that I read every year. Obvi, obviously his and Berkshire Hathaway and, and actually two or three others.

This one was interesting. It was, it was longer than most. He touched on a couple of healthcare topics. He touches on Haven. He touches on remote work. He and he touches on the competitive threats that are now facing banks from these, from FinTech and from other startups and digital companies. And it's really interesting because he makes in there that, that it full on competition Now.

That their technology in some cases is better. It gives a better experience all around, uh, for banking or lending than even JP Morgan. It with their size and scale can give. And when, when I was reading some of these things, I thought that's an interesting perspective, CEO, JP Morgan saying, look, they're not nipping at our heels anymore.

They're actually stepping into our backyards. They're actually making an impact. Are we? Do, do you think we're gonna start or are we already starting to see that in healthcare? Or do you think that dynamic is gonna play out in healthcare? I hope it does. You know, I got into healthcare 'cause I saw if inefficiencies and things that could be so much better for patients and.

Well, I don't know if we've had this conversation before, but I, I tend to, and I'm not saying this to brag because it's actually not a brag, I tend to see things like, you know, 10 to 15 years before they happen and I go, this is gonna happen, and I get all excited and then it's like, we have it. Wait, yes, it will happen, but wait.

And that's how, you know, with healthcare, it, it will happen, but I still think it's gonna be, it's gonna be a while and then it it to me like. The infrastructure costs are so high and the, the tech stays around so long. So if you think of the infrastructure to build a hospital and how long you have all of the tech that's in that hospital and you know, you know, think about, I was reading an article again yesterday about IoT and I was thinking so much about all those devices in hospitals that are either connected or disconnected and potentially security risks and things stick around so long that.

I think it's gonna be a while. It's, it's still going to be a while. And, you know, we are also seeing hospitals, you know, they, they've been on this innovation bandwagon and we can talk about innovation as, uh, you know, some people talk about innovation theater and it's just to try and look in innovative.

But I think that first wave of innovation was, oh my gosh, you know, there's all this stuff happening with the, you know, initial digital health. And it was innovation theater. And now though they were questioning the ROI of, of that and actually looking at how do we do different things? How do we partner with different types of organizations?

So the pressure's there, the change is coming, and I think we'll end up in more of a hybrid. That's my, that's my prediction, but it's gonna be a long time. Yeah. I, I just reading, there was a, for, I knew I didn't give you this one, but there was a Forbes article on Epic yesterday that I was reading and. You know, it was just reminding me just how big they are and how many hospitals they run and how that's not going anywhere quickly.

No, it's, it's, it's not going anywhere quickly. And that's one of the things that sorta, you know, having been in the CIO chair and having looked at it, the, the amount of money we spend on the.

Huge. And now a lot of people are would be listening to this and saying, well, of course it's Bill. It's the most important system we have. It runs so much of the hospital. I'm like, yeah, but no other industry does that. No other industry spends that portion of their IT budget and their staffing and their time on maintaining a system like that.

It's almost serving the system rather than really focused on, you know what, what it can do for the community or the patient. The efficiency, and so we're just constantly feeding that, that animal. But I, I don't really wanna go down that path too much. I, I agree. Me neither. What's that? I said me neither.

You know, I had another thought. What's that? This was a thought I had a little while ago, which is, but there's, there's a change that has to happen at all levels, but doctors are actually all trained in the system. Like they're trained in hospital systems and you meet doctors, especially younger doctors. I mean, it's terrible.

I shouldn't say that. It's not, you meet doctors of all ages who believe that things should change, but they're trained a certain way, and so they're coming into the system, being trained by the system that they're gonna work in. I. Which is different than I think any other industry. You're chain, you know, you may be trained at a university, but then you go out in the world and the, the business is very different than, you know, you learn the theory at the university, not the practice, but doctors are actually raised in that system and so they have to be part of the change.

And some of them will be because they're, they see, you know, things that aren't working and some won't because that was the path that they went through. I. So I think that's another tricky thing in, in shifting healthcare is that you cannot have healthcare without doctors. I mean, you can, we, we have all these examples of like, yes, you can have practitioners with different levels, but it's, that's almost like, it's a, it's a, I don't know what to say, you know, like a path or a pipe that is kind of reinforcing some of the ways that things are done.

But isn't that part of the point that the doctors are realigning? They're, they're aligned. Some are aligning with tech startups. I see a lot of tech startups hiring doctors away. Yeah. Some, some building full teams. I see. UnitedHealthcare is actually, you know, through Optum, just buying doctors practices all over the place.

And so they aren't, they are realigning and as that realignment happens, doesn't. That will be one of the things that will sort of give us an indication that the change has taken hold and it's starting to pick up steam when doctors are looking at the way, I'm sorry, when, when providers are trying to hire doctors and they can't get 'em because they've all gone to these alternative methods where they have a better, uh, quality of life potentially.

Yeah. Uh, uh yes, that you're right. That might tip the. It's just a question of, I don't know, you go talk to Doc, you know, some of the doctors at the top teaching hospitals and whether they're really excited about joining a startup and, and you know, as a startup, we had a couple doctors come through on rotation and.

They were incredible and they were unusual. And even with being incredible and unusual, you know, there was, there was the theory in the practice where, you know, we would be designing these care plans and they'd be like, well, you have to do this. And we're like, you know what? If you do that, no one's gonna use this care plan.

Like, there's people at the end of this and you have to understand what they're and aren't gonna do. So. And those were, you know, exceptional folks who sought us out, who said, I wanna go see what's going on in the startup. And they both ended up in, well, one of them that ended up in Kaiser. I'm trying to remember where the other one did.

But you know, they, they, but still, you know, Kaiser's still, you know, massive, massive health system. So, uh. I don't know about the Optum example either, 'cause I do, I just saw something recently where, you know, some small, I don't say small, but you know, anesthesiologist practice was suing Optum for something related to in the network, uh, network pricing.

So I don't know about how much doctors wanna be owned by Optum either. Yeah, I'm, I'm, I'm not saying that they do or, or want to, but I'm saying that when, when we see more doctors outside of the provider world lining with, uh, health tech, it, it, it'll be interesting the, this story goes on, you know, the, it it, it talks about one of the things that these, the FinTech companies have over the banks is they have a lower regulatory burden and they have a lower cost structure.

And both of those things are. The new market. In fact, Jamie Diamond actually calls for a, a review of the regulatory environment that these people, uh, the FinTech companies operate in because it does create an unfair, uh, playing field. And, you know, you could see that as, of course he's gonna say that. Or you could also look at it and say, well, there's a certain amount of truth to that.

So it it'll be interesting to, so how startup plays on, say. We need to make healthcare, the healthcare system work better, productivity

on. Especially around equities and those kind of things. We have the best healthcare in the world and in terms of doctors, hospitals, and pharmaceutical and medical device companies, but we certainly do not have the best outcomes. As I discussed earlier, 30 million Americans do not have any insurance, obesity, high blood pressure, asthma.

Diabetes and other conditions are rampant and costs are far too high. With little discussed earlier, 30 million Americans do not have any with little transparency into their calculation, and that's something we talk about a lot. Little transparency. Uh, we don't know what we're getting when we walk in that front door at a, at a hospital.

Annual medical costs per person in the United States are now 11,000 versus 4,000 in other developed nations. There are ways we can make significant improvements. Allow incentives for becoming and staying healthy. Eliminate bureaucracy and waste in the healthcare system, include adminis, including administrative complexity and fraud, which is about 25% of healthcare costs according to his findings.

Empower employees to make better choices through more transparent employer plan pricing and options that include the actual cost of medical procedures, eliminate. And a couple other things. He goes on to a couple other good things in this and you know, it's, it's interesting. That's the perspective of a, a large employer who essentially is looking at this saying, look, my benefits meeting is contentious every year.

We raising the cost of, of delivering care. It's becoming harder and harder to give people what they want. Given the options I have from the insurance carriers and whatnot, there aren't really good options. I'm hiring a younger crowd in metropolitan areas who wanna stay healthy and they want a different looking kind of plan, and we're not seeing that emerge yet.

We want, they want a plan where somebody is monitoring them seven by 24 with the devices that they have put on their wrist and other things. They're willing to share that information. Very few doctors and health systems are willing to track that information and take responsibility for that information to say, Hey, I'm, I'm tracking that information for you and this is what it looks like.

By the way, if you have a question, go ahead and text me. And then when you text them, they actually get back to you and say, you know, Hey, I, I'm recommending that you talk to a nutritionist. And a nutritionist is part of that, you know, when we're talking about this, this upcoming group of people entering, they, they, there is a propensity to wanna stay healthy.

The plans are still designed around sick care much more than they are around health and wellness. Even, even some of the, uh, corporate wellness programs are just okay with, with regard to that, a lot of interesting things. What have you seen with regard to the, the, the corporate world in terms of care and the expectations and the challenges that they're facing?

Yeah, I mean there's so much in there, bill, so much. It's an interesting thing. I, I would say certainly pandemic related. I've seen a lot of focus on mental health and mental health programs, which is great. And I think, you know, that's kind of the start of it. Like that there's so much relation between your mental health and your physical health.

Like if you are. Really stressed that is affecting things that also you might, you know, that's when you don't eat well, that's when you might not exercise. So I think that's a really interesting place to start. My, when you were describing this though, my first thought was this is what's JP Morgan doing for the health of the employees?

'cause it's not about the health plan. I was thinking about this as, okay, I live in Seattle and we all know what Seattle's like. You know, people are outdoorsy and, you know, running all the time and, and, but it is, it is, since the pandemic has started, every time you go to the wilderness , there's so many people there because there's nothing else to do.

And also because people have more time, they're not commuting to work. And so, you know, I thought about this like lifestyle change that, I mean, it's. Not a complete change. 'cause we were already pretty healthy and active out here. But work has shifted to allow people to live more healthfully, you know, and they're also eating at home.

So they're not eating, eating out as much. So I have this question around, you know, it's one thing for the employers to say the health plans aren't giving us what we need, but what are the employers doing to start with? To encourage a more active lifestyle for people. I was thinking back, you know, years ago, years and years and years ago, no, when I used to work at Microsoft, we moved into an a brand new building and the building had gigantic stairwells like, like I can't describe, like they were this wide as a whole room and they were painted with murals and the whole point was, don't take the elevator.

And it was a five story building and most people took the stairs because the stairs were actually pleasant. And I have gotten myself into trouble so many times in office buildings where I tried to take the stairs and then I'm like, you know, getting spit out into a parking garage. 'cause all the, the doors are locked.

So that's my first question, like, what is the work environment doing to encourage. People to be healthy and not, you know, necessarily sitting in front of a computer all day and more time to get out and even just, you know, walking up the stairs in the building. And then the second is, you know, this question around do doctors really need all that data?

Especially if somebody is, is healthy. So, you know, I, I kinda go back and forth on this, on the . We need tech from a tech standpoint. We need to make sense of the data. We can't just be, you know, I remember, you know, when I first started in digital health and Fitbits were all hot and people, especially in Seattle, 'cause we're all fit, we're walking into their doctor's office going, here's all my Fitbit data.

And the doctor's like, that's nice . You know, like, what do I do with this data? And I think that's where the things become interesting is. What, what are your goals and what are the anomalies in this data? Or what can we learn from this data? And not just like, here's all this data you're tracking 24 7. And then what?

And then, you know, going back to my previous point, like medical schools aren't training doctors to do wellness care, so, so there's a whole bunch of stuff that has to, has to shift. And then there's this question of like. You know, I, I've seen the data as well about do wellness plans and employers work. So there's so many components and I, I do agree that the, you know, the offerings that, first of all, when you're choosing a, a health plan, like you, you can't even tell, like you, you just wanna be able to say, this is me and this is what's important.

And there's no plan that enables you to do that. So that might be the first step. That would be really interesting. And, and certainly employers can drive that. But I've never, you know, I've, I'm working at Amazon now, I've worked at Microsoft. I've never had an experience where someone has asked me what I need in a health plan.

Yeah. That might be the first step. Maybe they're overbuying because they're not actually asking, some people only want CATA catastrophic. Right, right. You know, it's interesting. I, I'm gonna violently agree with you on the first one. I mean, I mean, that's such a great point. We, we can stand there and say, you know, this doesn't work and health systems aren't providing this, payers aren't providing this and whatnot.

But you could just do a tour of the facilities that these organizations have and say, alright, what, what have you done for your employees? And you could do a, you know, just a, a, a brief survey of the employees to talk about, you know, the work life balance and kind. Are they creating an environment where people can be?

Well, that, that is an excellent point and I'm, I'm glad you made it. The second one is, and, and you, you sort of came around to it at first. What I heard you saying is, you know, they, the people would walk in with their Fitbit data and, and the doctor would say, yeah, what do you want me to do with this? And the point being, we've never asked the consumer what they.

And, you know, I tell a bunch of different stories around this and I'll, I'll spare, spare the audience because I, I, I've told some of them several times, but there were several times in my CIO career where we got pretty far down into a project and finally said, Hey, what do the patients want? And we got, when we finally asked that question, we realized, hey, we just wasted six months because we didn't take the time to understand what people want, you know, as employee.

Of a major organization or just a, an employee in general? As an employer, I'm an employer. Now, you know, what I want is, I want a plan that is gonna take that information and have something monitored. And it doesn't have to be a doctor. I don't expect it to be a doctor. I just expect it to be somebody who is trained medically, who can look at it and say, yeah, there's no anomalies.

Now we can talk about what needs to be done on the backend, you know, ai, machine learning, those kind of things. So we just don't dump a bunch of data in front of that clinician. But I, I, that, I do want that, I wanna offer that to my employees. 'cause I think my employees are saying, you know, I, I got this device because I wanna be healthy.

And that's the first indication I just sent. I mean, yes, it's a fashion statement and yes, it's cool to have the fill in the blank watch or cool thing or track your steps and, you know, track your, your hiking and, and, and different workouts and that kinda stuff. But at the end of the day, what that's saying to me is, I want to be healthy.

All right? Let's design the plan that works for the employer. Let's design the plan that works for the employee where they're, and where they're trying to engage. And yes. Around sick care and those kind of things. I, I also don't wanna be locked in to the, to the, uh, health system that's down the street from me.

I can get on an airplane, I can go somewhere else and I wanna go somewhere else. If I live in a place where the, the health system down the street doesn't make the, you know, US news and world rankings and I want to go to somewhere where they do make those rankings, I wanna academic know a certain level, care around.

Cardiac, or, or, or cancer. I wanna be able to do that as well. So I, I want, I, I want more options than, than what I, what I'm currently seeing. And by the way, I just signed up yesterday for my company's, you know, what we're gonna offer to our employees, and I'll just tell you, it's just weak at best. Yeah, I, well, I, I also, it's funny, you know, many hats I had also was an employer with a health plan, and it's, that's another interesting thing, like, you know, we, we had.

Well, first of all, we needed help. We needed a broker to help us figure out, you know, what the heck do we offer to employees. But it was very interesting to monitor it as well because I have very healthy employees with almost no claims . And so, and I didn't do, you know, it was nothing. I wanna say, actually, I didn't say it was nothing to do with me.

We did actually put the office in a place where . Most of the people, we had one person who drove and everybody else, well, no, that's not true. We had two people who drove, but everybody else walked or biked for most of the time. And so, and we'd made that decision when we were, you know, moving, uh, to a permanent office from a coworking space of where should we be so that people can be

Having a nice commute and be healthy and, and all of those things. So that was an interesting thing to watch that, you know, our premiums actually stayed flat or went down because we had this healthy, healthy workforce. So, you know, it's a very, very small model, but I think the employer can have a lot to, to do with it in, in facilitating and listening to the employees about what they want.

It's interesting as you you're talking about that I, I'm, I'm scanning this and it's like a 60 page report that in new report that they put out for JP Morgan, he talks about work from home. And here's, here's some of the things he said. Generally speaking, we envision a model that will find many employees working in a location full-time.

That would include nearly all the employees in our.

Operation function and facilities, amenities, security, medical staff, and many others. Some employees will be working under a hybrid model some days per week in a location, et cetera, and a small percentage of employees, maybe 10%, will possibly be working full-time from home for very specific roles. He has.

He goes on to talk about the virtual world, also presented some serious weaknesses. For example, he has four weaknesses that have presented at least four at JP Morgan. Perform. Performing jobs remotely is more successful when people know one another and already have a large body of existing work to do.

It does not work as well when people don't know one Another second thing was most professionals learn. Apprenticeship model, which is almost impossible to replicate in a Zoom world. And I'm, I'm really curious what your thoughts, because you've, you've worked in these models. A heavy re reliance on zoom meetings actually slows down decision making because there's little immediate follow up.

And the, the fourth thing is remote work virtually eliminates spontaneous learning and creativity because they don't run into people at the coffee machine, talk with clients, et cetera. So he, he notes that there's those four challenges and it sounds like for the most part he's saying a majority of their workforce is going back to the office.

Yeah. That's a, that's a hot topic these days. You know, I'm, I. I'm fully remote right now, joined the company, fully remote. I'm doing work right now that I know how to do, and I think that, you know, I don't know the company, but if I didn't know exactly what I was doing, I think it could be really challenging, especially that apprenticeship model.

I think that was a good. A good call out at the same time, you know, you commutes are one of those things that really hurt people's health. You know, people who have long driving commutes in particular. And so, you know, a lot of, I, I've seen since pandemic people talking about they miss their commute because it was this break between office and work, but that they would actually be like going for a walk during their commute.

Like they get up. Go for a walk, come back, start working to sort of, you know, mimic that commute. So I think there's also this, like, you know, there's a difference of energy that you get when you see somebody in person. We're missing a lot of the nonverbal cues. You know, you're having a meeting, you can't see everybody's face at once.

You don't know who's not bought into what you're, you know, trying to decide on. So I, I think a hybrid model is, is gonna be. Possibly the best. I think this, this, going into the office all day, every day, you know, the, there's a lot of quiet thinking work that is very hard to do in an office. So, but I don't know, it's gonna be interesting.

Yeah. I'll agree with you. Uh, the last two points he makes, and then I, I want to hear about your story. So while we disbanded Haven, we'll continue to build on what we learned. What did we learn from them? Do.

No, I mean it, yeah, I, I say be careful. I, I was always puzzled that my, this is my, my main point with Haven, I was puzzled about how you could be ACEO of a startup, a full-time. Professor at Harvard and a correspondent for a magazine, you know, top magazine. That was my, my query was like, each one of those seems like a full-time job.

Yeah. That's my only comment about Haven. Yeah. Speaking, speaking of. Yeah, it, it didn't seem like he got all into the boat. It seemed like he was doing a lot of other things. Like my takeaway from that was like, oh, it's not very hard to be a doctor or a professor at Harvard because you can also run a startup at the same time, and, and be active on social media and publishing articles and stuff.

Yeah, I, I mean, I've talked about that a bunch and we're gonna see we're continue see innovation. Mostly from Amazon because they're the most innovative company of those three and, and just in the way that innovation will need to happen in healthcare, I don't think we're gonna see Berkshire and JP Morgan Chase do a lot of innovating.

They'll invest in innovation, innovation in healthcare, but not, not much in the way, but you know, we'll, we'll keep an eye on Amazon care and other things. The last point he makes is cyber risk remains one of the most significant threats to. I, I think that's really true and, and I had a, a meeting yesterday with a client and, and we were talking about cybersecurity and.

They, they were sort of pushing on me a little bit and saying, you know, why don't the CIO see how much of a threat this is? And, and my pushback was they absolutely see how big of a threat. It's, I mean, for the first time in our history, we saw entire hospitals shut down. We saw medical images just go up and smoke essentially.

And, and health systems had to start over with zero images and zero information in their EHR. And try to rebuild from scratch. So this has definitely caught the attention of the, of CIO. The thing that's interesting to me is I think it's caught the attention of CEOs across the country, and I think it's caught the interest of our federal government and, and other agencies.

It, it'll be interesting to see how we progress. Public, private, uh, partnerships around this. I think we're gonna see a lot more meetings like I've seen within healthcare, where you essentially have the FBI coming in and briefing CIOs for healthcare organizations. This is a, this is a serious threat to our economy.

It's a serious threat to, to healthcare. This is the first time healthcare has been targeted as an industry. It's really, that's really interesting. So that's the last throwout point. I wanna hear your story. You have some interesting. Yeah, so I sent you three stories on similar topics, talking about health tech for women particularly, you know, middle-aged women.

And then one of the one was an opinion piece from a, a doctor that was about data. And after I sent you these three articles, I realized that they were reminding me a bit of a book that I wanted to recommend. And I know I come on here, it's supposed to be news. I'm always recommending books. But there's this book that I read, I, I, I think our listeners read books as well.

Do they, do they read books? Well, I recommend that they read a book called Invisible Women Data Bias in a World Designed For Men. If there's if, especially in healthcare, because there's a couple chapters on healthcare, and particularly the health implications of not having the right data. And I think for anybody who's in, you know, ACIO should be really thinking about the data that they have.

And that's what sort of got me thinking about it was. , the, the one article, the opinion piece from the doctor who was saying, you know, how, basically some of, some of what we're saying is, you know, people are not paying any attention to, to women's health. So let's just start with that. There's a New York Times article that says the title is, is Fem Tech the Next Big Thing in Healthcare?

lation. And yet, you know, in:

Which, you know, on the one hand if you don't know much about venture, that seems like a lot. On the other hand, you know, we have companies that do, I don't know what, just marketing tools, what we, I don't have a good example right now, but you know, these companies valued at a billion dollars individual companies, right?

And. Less than a billion dollars was put into all of this technology. So that's one, one sort of piece of it. And so there's this idea of like, you know, this is actually a business opportunity. It's also a, a healthcare need. And that, you know, at the, this article is talking about how, you know, women aren't represented in medical research.

There was concerns about whether women could be pregnant. And so they're not represented in medical research. And then there's just like the, you know, all of the systems. . You know, if you think about the EHR and you think about the kinds of questions that get asked, like things that are just not even appropriate, you know, I've had, you know, my mom being filling out a form, being asked if, you know, is there any chance she's pregnant?

Well, like, come on, . Uh, so the, the data is incorrect and there's not enough of it is one of the, the challenges. And then I started to question, you know, like the, these apps are coming up because of this issue of like, there's nothing tailored towards different, you know, stages of a women's life, whether that's, you know, the fertility side of it, which was the first one, the first area that's really started to

See in this traction. And then I think in the last three days I've seen a number of companies focused on menopause, which is another one where in this this opinion piece, the doctor is saying, you know, I asked a bunch of residents whether they had any patients in Meno, meno, menopause, and they also said no.

And it's like, that's not actually possible. Given the demographics of the patients that you're caring for, sheer numbers does not support your statement. Sheer sheer numbers do not support your statement. So the, the point I wanted to make was, well first of all, you know, there's still this sort of condescending, you know, like, is this an opportunity?

Yes. Yes, it's an opportunity , but anything is an opportunity not just for technology that is specifically aimed at, you know, women's health, but it's an opportunity for thers, for example, to think about like, how are we collecting data on women's health? It's absolutely an opportunity for clinical trials to make sure that they are representing a, a diverse population.

So there's also . There, there are other diversity issues in, in clinical trials as well. But it did sort of take me back to this, this book, you know, which I think when you read this book or if you read this book, you would see the answer to these questions is yes, like we're missing a ton of data that could improve health, it could improve all kinds of products.

And so, you know, one of the things I was remembering from the book was, you know, crash test dummies were tested on the average male and medical. Medical textbooks were based on the average male and so , it's like we could be doing so like low hanging fruit from so much of a better job of both collecting the data and caring for diverse populations.

So that's fine. Yeah, it's, it's interesting and, and I have a hard stop in two minutes, so, and I apologize for this. I really wish I. I wish I had given this more time. 'cause I, I agree with you. You know, I, I won't pick up the book. I'll read the book. I, I, I'd like to get more educated on that. But I will say from the, from the investment side, you know how investments work right there, there has to be an economic model on the other side of it.

And prior to Livongo, there really wasn't anything for diabetes, right? 'cause the, because it was hard to build the financial model based on the incentives. I think that's where the question of is fem tech, the next thing, can we build the financial models to support, you know, the, the large and diverse population that is women with, with startups, it.

Yeah, it will be. I think that they're right now filling a, a niche or I wanna say a niche 'cause it's not a niche, but they're filling a gap that the larger players are not looking at. So there's off always an opportunity when someone's ignoring something and then eventually, hopefully it should become.

Integrated. Yep, absolutely. And thank you for your time. We had trouble scheduling this this week. That's why we have a shortened session and I, I apologize for that. We're, we're both running around a lot, so thanks for your time. I appreciate it. And, uh, look forward to the time we get together. Sounds good.

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