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 Welcome to this Week in Health It where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is episode number 26. We're officially halfway through the year. It's Friday, July 6th. Today we look at. The startup landscape and social media support in fighting the opioid epidemic, say that 10 times fast.

Visit health lyrics com to schedule your free. My name is Bill Russell. We're covering healthcare, c i o, writer, consultant, and with the previously mentioned health lyrics. Before I get to our guest, an update on our listener drive, we've exceeded 200 combined new subscribers to our YouTube, uh, YouTube channel and podcast outlets, which means we raise $2,000 for hope builders, which provides disadvantaged youth, the life skills and job training they need to achieve, enduring personal and professional success.

I've hired their graduates. Their stories are. Uh, you just have to love, uh, giving these kids, uh, an opportunity for a second chance. Uh, we have, uh, six more weeks, uh, where our sponsor will give a thousand dollars for every additional a hundred subscribers. Uh, two wins for the price of one. Listen to great content from industry leaders like our guest today and give back to the community while you do it.

Join us today by subscribing, tell your friends and, uh, you know, just follow us. We we're posting a new video out on YouTube every single day. So, uh, today's guest is the c e o and co-founder of Well Pepper, a clinically validated and award-winning platform for digital patient treatment plan. She co-founded well Pepper in the late.

And Wheeler joins us and, uh, welcome to the show. Hi, bill. Thanks for having me. Did I mispronounce your name? You did. It's Weiler. Weiler. There you go. And, and actually, even in the show notes, I spelled your, your name wrong, so I know. There we go. We're up to a great start. Yes. We've actually known each other for a couple years, you know.

I know, but we don't, we don't, we don't. I don't know. We, we don't spell each other's names. It's Ann with an E. For those of you who are following along at home, uh, I don't. I don't know how I keep getting that wrong. I had it wrong on the website until this morning, so, Uh, so you left, you left a well paying job I did with a strong organization to found a digital startup, uh, in health out, out of really a personal experience.

So tell us a little bit about well, pepper and, uh, and your journey. Now I'm saying well pepper correctly, right? Yes, that is correct. It is . There we go. Um, so we have a, a platform for patient facing care plans. So if you think about the. You know, the way care plans have evolved, for the most part they've been in the E M R.

What we have is what needs to be delivered to the patient, and we take the approach that patients can and will self-manage if you give them the right tools. So a lot of what the patients are getting today are not instructions or. Even information delivered in a way that they can do anything about it.

And so we've really seen a shift over the, the years that we've been doing this from providers saying, it doesn't matter what I tell them, they won't do it to providers. Understanding that if you give them. Something that, you know, is actionable, manageable, and really broken down and based on, on research.

And that's not just clinical research that we're doing, but it's also research of how people are interacting with their care plans that you can learn from that and you can get something that a patient can follow, can adhere to, and even improve their outcomes. So are you, are you leveraging other people's research or are you doing, uh, some original research as well?

Well, we are, we've been very fortunate. We have a couple research partners, um, one at Boston University Center for Neuro Rehab and one at Harvard. Um, and they've done randomized control trials. So we've, um, we've been very fortunate in that we've just been able to partner with them. They use the technology to deliver their interventions outside the clinic, and then they test.

Uh, the outcomes on that. And then we also, as we're collecting patient data, so, you know, I think one of the most interesting things is this is a channel for new data and it's data that's patient generated, what patients are doing against their care plans. We're starting to analyze that. So we know things like if you want someone to be adherent to a care plan, five to eight tasks is the optimal number.

We also know that 70% of the messages that patients send in a system like this, Don't need a response, and 2% of them are urgent, and those are the ones that you wanna get back to the providers, which goes back to our philosophy of this isn't about, um, managing a patient. This is about en enabling and empowering a patient and then connecting them to help when they need it.

Yeah. Well you, you're very, uh, one of the things that I think, um, that has been the foundation for our relationship over the years has been you're very pragmatic. So , I mean, you have, yeah. I mean, can you give us some stories or some examples of, of outcomes, uh, from your technology? Yeah. Yeah, absolutely. Um, so the, the randomized, um, control studies that I talked about, the, the one, uh, was done with people with Parkinson's disease and the people who had the digital intervention versus the control group who basically had paper usual care condition.

Um, the digital intervention on 9% improvement in mobility versus a 12% decline in the control group. And that was over a year. So that's a real physical . Improvement. Um, the, we did a falls prevention study with Harvard, um, because this is being recorded. I can't tell you the actual details, but, uh, Dr.

Jonathan Bean, who's a physiatrist, was the principal investigator on that, and he has clinically meaningful outcomes that were maintained at one year and they're really good. Um, these are preventing people, seniors, 65 to 85. Actually nine five, um, from having falls, but we've also found things within our own data.

So from patients reporting their side effects after surgery, we were able to identify people who are at three times greater risk of readmissions. So I think that's like, it's a combination of, of course you have to do validated independent research, but you also have to look at as this data is coming in, what kinds of things can you find in this data?

Um, and preventing readmissions is a, you know, of course, I think a top goal of any type of system like this. Right. Um, so one of the things we like to do is ask our guests, you know, what's one thing they're working on that they're excited about? Maybe we just covered it, but, um, , you know what? Yeah, yeah, definitely.

Um, so we we're, there are two things I'm gonna say. One is that we're applying machine learning to the data that we're collecting. I am laughing because there is, there's a dog here who is telling me that he needs water. And he's doing that by putting his paw in his water dish and dragging it around . Um, So we're gonna, I'm gonna pause.

This is, this is gonna be the edit part. Can we do that? I'll, I, I'll pause. You can, uh, give the dog water. So there you go. That's, that's recording. Live with a digital health startup. That's just what happens. The dog came in the room and you have to give the dog water so, Please continue. Yeah, we have many stories about this dog interrupting conference calls and things.

Um, okay, so we're applying machine learning to all of the data that we're collecting and using that to help scale the clinicians. So we have a machine learned message classifier that looks for adverse events in patient messages, and that's used in surgical scenarios. So if someone messages something that

It's been trained to say, oh, this might be something that's urgent. We'll alert the care team. And we did that by starting off, by analyzing all the data that's coming in. So the approach that we take is we get a channel of communication flowing of whether that's structured or unstructured data of patients.

Interacting with their care plan, and then we start to analyze it so that we can learn things so that we can suggest things to the clinician and make their lives easier. Again, coming back to most patients don't need this active monitoring, they just need help if something's going wrong. So that's one thing we're very excited about.

Um, and then the other is the marketplace that, uh, we announced . For care plans. So this is for health systems to be able to share their best practices and have other health systems use them. Uh, and our launch partner for, that's Mayo Clinic. So what happens is as we, um, implement Mayo Clinic's patient facing care plans on our platform, we can make those available for others to use.

And that's another place where the data starts to become very interesting. It's not just the data of Mayo Clinic's patients using these care plans, it's the data of other health systems using them. And we're also, we'll also make available these protocols like the ones from Boston University and Harvard that were used in these randomized control trials.

And I have no idea why we did that. We, we have since, since changed lawyers. I think he must have had like some quota or something. It made no sense. It meant we had to file taxes for a year where we had no business whatsoever and just made things confusing. So really five years.

That, that's, that's really exciting. So here's what we're gonna do. We're gonna transition to the show. We, uh, you know, we'll do in the news, then we'll do some sound bites. I'll ask you some questions, and then, uh, we'll do a social media close. So, uh, let's go ahead and get started. I'll, I'll start with, uh, my story, which is, you know, I figured having someone like yourself on.

Uh, we, we could talk about this whole startup scene. So, uh, yeah, start Startup Health just, uh, released their mid-year report, uh, funding topped $6 billion across 414 deals, and then we're at the halfway point of the year. So July marks the end of another record mid-year report in digital health. More than 6 billion raised in the first two quarters, 20 18, 414 deals.

That's the largest midyear deal count to date. 60 deals more than we reported last year at this time. This increase in deal count is partially due to the rise in in new international hubs of health innovation. Mm-hmm. , particularly across China, which dominates global market with over half a billion US dollars invested.

As the market expands globally, we're seeing every section of the market receiving funding from insurance to biometric data acquisition. They release this report, report, they do it, they do it every, um, I, I think every six months they actually, uh, re release the report. I could be wrong. Maybe they do it quarterly.

Um, I, I don't think it's gonna continue at this pace, but I'm always a little bit of a pessimist. Uh, I'll say that I'm, I've been very happy to see this increase in funding. 'cause when we started, I talked to some prominent VCs in, in Seattle who said, I don't think anyone's funding digital health. And I was like, Hmm.

I'm seeing something different. But it's great to see both rock health and startup health coming out with these, these reports. But I do think you have to look deeply at what's being counted. I think if you remember last year, one of the biggest deals was outcome health. Um, and yes, they were digital health, but they were really pharma advertising.

And then turns out that, you know, I. Maybe they weren't even doing that. Right. Um, but if you look at the startup health, um, like point click care is an E M R that focuses on skilled nursing and long-term care facilities. So is that digital health? I guess so, but you know, that's not a new company. So if you look at the, the 10 largest deals, you kind of have to say, okay, which ones are really falling into this category and which aren't.

And I would say, um, you know, point, click care may not fall into that category. Oscar certainly does, but you know, they are . They are a payer. So it's just something to, to think about, um, of like, what is making up this, this category. I think China is interesting. Um, yeah, and, and certainly, you know, we're, we're seeing two things.

I think it was, I think I was looking this up. I think it it was Baidu who just, I. Dropped their digital health team. So there's like a whole bunch of weird things happening, lots of funding. And then, you know, Qualcomm is getting rid of their digital health. GE is getting rid of their digital health. So I don't know.

You know, there's a lot of fluxx going on and that's why I sort of feel like we could, that could be the. The beginning of maybe we're looking more at outcomes and revenue than funding as a metric. Yeah. Well, I, that would be an interesting metric. I, you know, , the, uh, well, you also, the layoffs at I B M around their ai.

Yeah. So, um, Yeah. So we see pullback in some areas. We see, uh, moving forward, uh, you know, the 10 deals that, that you were discussing, Oscar Livongo's on here, um, IRA Health, some of the others. Um, you know, so, but, but listen to the functions. I mean, I, I just find this interesting. So yeah, biometric data acquisition, clinical workflow, insurance, admin, workflow, research.

Pop health, education, content, patient empowerment. It really, usually when I look at these lists, I go, okay, I see we're starting to coalesce around a certain area. You know, whatever. It's, yeah. Patient engagement. I, I'm not seeing that. We're not coalescing around any one thing. There just seems to be, we're still at this point where it's scattered.

Let's scatter a bunch of money, let's see what happens. And. Uh, then we'll put more money into it later after we see which one sort of gets, uh, right traction. Uh, I, I mean, I, I, it's not really a question. It's more of an observation of, um, is the money gonna eventually tell us who the winners and losers are gonna be?

Because it's, it doesn't seem to be yet. I I don't think the money ever tells you that. I mean, if you look at just typical VC firms, right? Only 28% of their investments make . So most that's telling you that 70% basically are not. So if you're, look, if you're looking at that, that's probably one or two or three that are big, and they're probably not in the same categories.

But I think that, you know, the funding is reflecting what's happening in the market too, because all of these new. Mergers. Like I was thinking about this, you know, in your, in, well I'm jumping ahead, but, uh, in your question that you, you gave me in advance, I won't tell you the answer to it right now, but like, you think about all these new companies, like what kind of technology do they need?

Are they gonna build it all themselves? Like the, you know, the JP Morgan, Berkshire Hathaway, the c v s Aetna, like these are different types of companies. What kind of technologies do they need? And, and maybe that's why the technology investments all over the map too. Like we don't know what the new healthcare organizations are gonna be.

Certainly we're seeing, you know, the payer provider coming together. But then you're saying seeing payer and pharma like, or retail, I guess if you look at C V Ss. So it's, there's a lot of interesting things going on and, and maybe that's where we are. Um, someone told me at the HIMSS venture, uh, event this year, that this year is the year of security.

And the winner was, uh, someone that did basically device security for old devices that could be security risks. So, which is interesting 'cause I'm not seeing, I'm not seeing that in the funding, but maybe security companies don't need. Hundreds of millions of dollars. . Yeah. That's, uh, that's interesting that they're, they're not in that list.

'cause I, I'm, I'm hearing the same thing out in the market is just the, the amount of money healthcare is, is driving towards, security is going up and this device security has, uh, been overlooked for decades. And, uh, now it just, it needs to be addressed. Um, a lot of that is because biometric devices don't fall under, uh, traditional it.

They fall under clinical and clinical. Yep. Didn't have a, a sort of a digital mindset around it. And so, yep. Uh, yeah. So let, let's talk about the International Metro Hub. So they have this chart and they, you know, London has more deals this year. Uh, India, China, a, a ton more deals. Toronto, uh, Uh, just, I mean, you have all these, uh, international hubs, um, and obviously that's gonna spark, you know, more innovation and whatnot.

But talk to me, I want to just get more down at the nitty gritty. So are you focusing more on. Like the US market, or are you being pulled in other markets? And if you do get pulled in other markets, what kind of criteria do you look at to say, well, I, you know, that's, that's gonna be too much development, that's gonna be too much whatever to do that.

Um, yeah, I, I, we get inbound from other markets all the time. Um, and sometimes we get pulled there from . From partners. Uh, we are mostly focused on the us Our data's in the US and our product is currently only available in English. Uh, but it is set up to be localized, so it's very easy to localize. Um, and so the criteria we look at is, is questions around data location and you know, whether it's, whether it's a showstopper that the data is located in the US and if it is, you know, then we may just.

Move on from that. Um, or if it, if it is a showstopper, but they have the, they're willing to pay for a dedicated instance in another country, that's totally fine. But it's always this sort of trade off between like, no, the data has to be in my country, but I'm not willing to pay for a dedicated instance.

Then it becomes cost prohibitive. So that's a question that we look at. We also look at, you know, really how . How real do we think this is and how quickly do we think it could move? Because there's this, you know, I, I'm actually Canadian. I don't know if I should say that, but I'm, especially the day after or two days after Independence Day.

Um, and you know, of course I would love to, to have our product deployed in Canada, and you would think that a product that is going to help people self-manage and lower costs would be extremely . Received there because it is a capitated model. Um, but they're just, they're actually possibly slower moving than the US and I think it's because the systems are so much larger.

Um, and then so we are constantly in back and forth in this, you know, where's your data? Questions like that. Now the nice thing is we're on Amazon Web Services and they now have servers in Canada, so we could put a dedicated instance there, but those are things that we think of. Um, so we're not against other geographies, but as a small company, you do have to focus and.

If you can't have someone on the ground in that country that is, or a partner who's basically completely representing you, it's very, it's pretty hard to, to do that. Plus, I mean, there's still so much opportunity in the US right? Well, uh, obviously Yeah, that makes, that makes a lot of sense. And the, the thing what you said, which sort of struck me is, you know, you can localize pretty easily, but having you been pulled like in, in, uh, the Southern California market, obviously we have

Uh, many languages. Yep. Uh, and I mean, haven't you for multiple languages just serve. Not yet. Um, but we can do, we can do two things. So when I talk about localize, there's the chrome of the app, like the buttons, the okay button, and the right, you know, cancel button. The content can come from anywhere. So the content, we do have content that's in other languages.

So if it's a video, um, explanation or text content. So think of the, the application is we have the building blocks that deliver the various activities to a patient. The Chrome on that. Is in English, but the content within it, the, in the specific instructions could be in any language. Well, except for the multi byte character, right.

Uh, right to left. But anyway, I just, but, but the video, so as I said that, as I said, that obviously could be in any language that you want. I hear, I hear the engineering team going, no, not any language. , some languages take up more space, so, so we can deliver content, like educational content and instructions to patients in any language.

It's just like the . Chrome of the, currently in English, it's a simple search and replace on string, so it's been, it's ready. Like we, my co-founder and I both came from Microsoft, so we knew we had to build a localizable product from day one. So, I mean, the, the takeaway from this is it's great that there's a lot of money going into the space, funding innovation and whatnot.

We probably need to look at if there is another metric to, to see, you know, what the outcomes of Yeah. Uh, each one of these products. That would be, that would be, you know, I'll start looking for that metric. I mean, have you seen something out there that people are measuring? Well, you know, well, I mean, I know, um, Evidation Health is trying to do that.

They're trying to say these are, these are products that actually proven to work. But I don't know that there's an an industry metric. Um, you know, a lot of it's like coming, we were, we were pretty early in, in actually partnering to do a randomized control trial. Um, and I think you're starting to see more of that.

And for us, we didn't drive that. That was actually, we were fortunate to meet. At BU who wanted to do digital interventions. Um, and so that just happened that they ended up using our product and testing our product. So I think that's another question I've seen is like the, who's actually doing the validation of it?

Um, and granted, you know, you, you do have to trust like some of the data that we're collecting, but I wouldn't, you know, it's, it's funny because when we talk about the data that we're collecting and the, um, the outcomes we're seeing from that, people have asked me, well, how come you haven't published on this?

And I was like, well, 'cause my standard for . Validated is extremely high. And you know, I, I would want hundreds of thousands of data points on each thing before publishing on it. Right. Um, and we're still, I think we're still a little wild, wild west out here on. What is, what does validated mean and what does success mean?

Well, and that's, that's where some of the cynicism is coming from, of what is, what has been the real impact of digital health. And I think it is because we don't have an a body of knowledge yet, and we haven't had enough, uh, in, in enough years yet of doing it. So, uh, I'm gonna kick it to you for your story.

If you could set it up. Yeah. So my story, it, it was a story from June, um, from Stat News, and it was about, uh, Facebook. And they're redirecting people who are searching for opioids to a federal crisis, health Healthline. Um, and I was actually surprised at how little play this story got. Um, and I'm not sure if it was because there was a bunch of Amazon stuff happening and every time they, you know, showed some indication of something else in healthcare, people.

Get very excited. Um, but I thought this story was interesting for a couple reasons. Um, one is that, um, you know, of course it's reminding you how much Facebook knows about you and your health. Um, and I actually think they know far more than I. They're letting on, or if they were to do more analysis, they would find a lot more.

Um, so if you think about like, you know, some people are, are searching on Facebook to basically buy opioids. Um, there's that, there's the Instagram filter study that shows if you're depressed. Um, there's probably things about like how you're interacting with people that are showing both your state of mind.

And then there's also, if you think about it, there's that, um, Evidence that shows that, you know, if your friends are overweight, you're more likely to be overweight. Well, Facebook's gonna know if your friends are overweight, at least mostly. I mean, they're always, for a while they were sending me all kinds of plus size ads and I was like, I'm not sure why you think I'm plus size, but okay.

At least you don't know everything about me. Um, so, so I think it's interesting 'cause like I, I think we, no one talks about Facebook, um, and health very much. Uh, and so I think it's great that they're trying to help. Um, so that's also, you know, like they understand that they can identify a problem, they can try and help with it.

Um, but I also think that, you know, we're not looking at some of the key causes in the opioid crisis. So, um, and I think that, um, one of my, one of my favorite books, which is, uh, Elizabeth Rosenthal Falls an American Sickness. She really breaks down how, how do we get to these places? And you know, if you think about the, the opioid crisis, it's, it's over-prescribing.

But, um, but you can't blame the doctors for over-prescribing 'cause the over-prescribing is actually coming from hcaps. 'cause there's an HCAPS score of was your pain managed. And so there's this sort of expectation of pain management and in particular we do a lot of work, um, with total joint replacement.

Surgery and when someone is prescribed opioids after total joint replacement surgery, they're always basically prescribed a large number because you can only prescribe them in person. And so if you just had your knee replaced and your pain's not managed, you can't get back in. You can't physically get somewhere to pick up a prescription, and so they give you too many basically in case there's a problem.

And then what happens is, you know, we actually in doing a, a focus group with patients, not patients that were our patients, but just patients, people who had had joints replaced. We, we heard about a patient who, she took all of the opioids that were prescribed to her because they were prescribed and the doctor told her to, to do so.

So one of the things that we do is, is in our software, . Pre and post surgery, we're checking pain medication usage. So, and if someone's not tapering off fast enough, we can alert the care team. So there's a bunch of things going on here. There's, you know, how did we get to hear how are people being educated about these drugs and you know how to take them and how, you know, how quickly to stop them.

Um, and, you know, how do you, how do you think about really closing this full loop? So it's great that, that Facebook is. You know, solving this or, or trying to come up with a solution, but it's almost like it's too late. So how do we, how do we think about moving these things up further? Yeah. You know, the social media aspect of this is interesting 'cause I, I, we know social determinants, we know we can find out more from, I.

Our search histories, social media postings and, and those kind of things. Uh, you know, things we read, Reddit histories and that kind of stuff. Um, then, then potentially our medical record, uh, can tell us, which is kind of, kind of fascinating in and of itself. So that data, if that data was ever unlocked, Uh, there's, there's a, there's a wealth of outcomes that, that could be driven from it.

Um, you know, I, I struggle with social media because I don't, I don't know if it's media or a social platform, and if, if it's one or the other, I think it matters. Um, right. And, uh, you know, some of this is, I, I mean, Zuckerberg will say it's not, but some of this is just the increased scrutiny that's happening with Facebook, so, mm-hmm.

he gets grilled, he comes back. I mean, his response is essentially, look, Um, we, we get, uh, tens of billions of posts every day. And, uh, and there's just no way for us to review all of 'em. Which by the way, I don't agree. I don't believe is true. Yeah. And second of all, he says, well, it's really self-policing.

So everyone's out there, they see a, an opioid, uh, ad from a, a digital pharmacy that's not legit. Somebody will flag it, they'll review it and they'll take it down. Um, The reality is with, with machine learning, with, uh, ai, they, they can review all this stuff pretty quickly. Give it a score and say, you know, this is, uh, this is potentially illegal activity.

They can escalate that stuff. Have a team that looks at those escalated items and moves 'em off pretty quickly. The question is, should we, you know, should we do that? I mean, who's gonna create the filter on those things to say, you know, If it's, if it's media, then absolutely I wanna filter. I want them to look at everything that's on there and, and do it.

If it's a social platform, I'm not sure I want them. Putting together a filter that says, Hey, you know, uh, bill just said this to his group of friends, but we find that offensive and the way it goes. So, and this, this is that the, that fine line of who, who determines what, uh, who determines what goes out on these platforms, and then who determines how this data can be used?

We, I think we can both agree that, uh, illegal activity should not, I mean, if it's on there, if they should identify it pretty quickly. Um, well if people are paying for ads, like that's the thing, like a newspaper is not gonna like thinking back to print or even online newspaper, they're not gonna accept an ad from an illegal pharmacy.

Or at least if they do, they're gonna figure it out pretty quickly. So going back to your point of, you know, them saying they can't police that they're taking money from these ads, they can place it. Yeah. You, you would , you would, you would, you would think they want to actually, I think that the thing that, the thing to highlight here is, you know, you have, they're the first ones to voluntarily, voluntarily do anything.

Yeah. Twitter hasn't done anything. Oh yeah, definitely. Reddit, Google, Yahoo. Uh, binging. So, um, You know, we, we can, we can either come down hard on Facebook or not come down hard on Facebook. The reality is at least they're stepping up and saying, yes for this portion, we're gonna, we're gonna do our part.

Yeah, no, I agree. And that's why I was saying I was surprised that, that, that story got so little play because it is a, it is a positive story. It is, Hey, we know people are doing this and we're gonna try and get them help, as opposed to just ignoring it or profiting. How much, how much of an impact? I, I, I know this is hard to gauge, but I mean, Facebook I think has an a, I mean, less and less of an impact on my kids.

Clearly they've told me that, um, . Um, but it does have an outsized impact on our community. How much of an impact them police, self-policing and take taking these opioid, uh, ads off their platform? How, how much of an impact do you think that'll have? I mean, you, as you noted the, uh, Uh, you know, with, with, uh, total joint replacement and over-prescribing, that's just one aspect of it.

Yeah. But this is a social aspect. Will this have a significant impact on it? It, I don't think, I have no idea. Honestly. I think I, that's the nice thing is they'll know, they'll know if people click through on those. Uh, and I think, you know, certainly if anybody's on one of those hotlines, but asking where they heard about it, like it's definitely trackable.

But yeah, going back to the point of like, this is only a small piece of the puzzle. Um, the other pieces of the puzzle are, you know, starting upstream and also that, you know, apparently most people get, like most opioid abuse comes from someone else's prescription. So it's not that buying off prescription to begin with.

It's somebody had a prescription hanging around and somebody, you know, Found it. So I, I think the good news on this is we're mobilized, uh, at the J P M conference this year. Uh, I mean, just about everybody who got up there, I mean, Geisinger, uh, dignity, I mean, everybody who got up there had some, uh, aspect of, uh, yeah.

Story to tell on this. They're, they're laser focused on it, and I think we'll get Yep. When it has that kind of mobilization, I think you're gonna see progress. So, I, I would say, you know, our, our flag that we're always waving is involve the patient in it. Like, we wanna be, you know, upstream and there's like, some of our, our customers are doing things within the hospital to track prescribing and track, you know, possibly over prescribing or really keep it, you know, do you really need to prescribe this?

Um, but then the next piece becomes when it is prescribed. . Are you tracking what the patient took because pain medication is always prescribed as needed and no one's ever following up of exactly what you needed. And so we, we had that in there from the very beginning of trying to close that loop of let's not just say as needed, let's figure out did you take it and how, you know, how quickly did you your pain go away after surgery?

Because that's a. Really great outcome to track. So you're as well as a secondary benefit. So you're doing self-reporting, I assume, on that? We're, yeah. Okay. But it's better than like what's happening right now, which is no reporting . Right, right. No, I, I agree. So there's no reporting, there's self-reporting and then obviously PillPack and other things are, you know, digital reporting somehow getting back and uphill back.

Yeah, whatever. PRUs probably, yeah. Um, I'm sorry, pill packs on the mind. 'cause Amazon just anyway. Yeah. Um, we, so we, I I'm gonna transition. We introduced a section called soundbites. During this section, we typically, you know, just toss out questions, one to three minute answers. Um, if you wanna throw back questions at me, you can.

I cannot guarantee an answer, but, um, so let's, let's just jump into it. Uh, what's the hardest thing about being an entrepreneur in digital health today? Uh, I think it's probably the gap between some of the incredible work that's going on in say, like genomics and ai and people are getting so excited about potential and then the reality of EMRs and fax machines.

And so it's like, you know, at what point, you know, to, to use the crossing the chasm. At what point does healthcare make some gigantic leap forward? Because the things, on the one hand, some of the things that are gonna be possible. Or even possible today are pretty incredible. On the other hand, you know, we're kind of a foot in both worlds.

Like we're, we're using machine learning, but at the same time, you know, if we can't fit into a clinical workflow and integrate with a, you know, 20 to 40 year old technology , that is the system of record. Um, it's really hard. So it, it's kind of hard to have like both of these, these things going on at the same time.

Yeah. So the pace, the pace, the pace of play is, is hard. And I've, I've been on both sides of this equation now and, and with, um, you know, I've had entrepreneurs look at me and go, I can't believe you're not smart enough to see this. And I'm sitting there going, I'm stepping back and going, yeah, but here's what you , here's what you don't see.

And, but you, I mean, you clearly see it. I mean, it's the fax machines, it's, there's just so many aspects that need to. Uh, to be digitized and brought forward. The, the quality of the data, the, the number of silos that are available. It's like, I love your technology. I love where it's not you specifically, but anyhow, I love where they're going, but I have to figure out a way to plug this in.

And until we have those, those, uh, mechanisms, it's, it's very hard. Um, second question. So what, what makes a great health system partner for a, for a digital health startup? Well, you, you actually just said it. Uh, it's that understanding the bigger picture vision and knowing where to plug things in. Uh, because we're not coming in saying we have to be the only system.

And in fact, you know, we're not the system of record, but we have a very important part to play in helping patients. So wherever we come in and they see , The vision of where they need to get to, even if it's not to get there today, and they can see that, you know, today we may deploy like this specifically for these scenarios, but in the future we're gonna be part of a larger ecosystem, a larger overall digital patient experience.

That that's a great partner. So anyone who comes in says, yeah, we're going this way. This is a, it's inevitable that we're going to interact, do all of our patient interactions digitally. Not all of them, but like that there will be a consistent patient digital experience. Right. Tho those are the easiest ones to work with because they can also look at us and know that they're not gonna get backed into a corner because we have an a p I, we have microservices.

You know, you can deploy us white labeled, you can deploy us part of a larger system. Um, and budget budgets. Yeah, budget's always really helpful. . Yeah. Um, yeah. Um, people, people with a budget and a problem to solve, uh, tend to be, uh, and, and a sense of urgency tend to be great partners. Yep. Uh, So, uh, you know, one of the most important things, uh, startup for a startup is focused, you know, we talked about this a little earlier in terms of, you know, will you go to another country and and, you know, and, and the hardest thing for you is, yeah, there's opportunity.

But, you know, let's stay focused on, you know, what our mission was, which started with your mother. Uh, let's assume you're starting a new startup. I'm not trying to take you in a new direction right now, but . But let's assume I'm putting you in a different role and you're starting a new startup. What area would you focus on right now?

You're on patient engagement. Yeah, patient enablement. What, is there another area that you're looking at going that's a great area? Well, you know what's really interesting is just in the time that we've been doing this, which on the one hand seems like a long time and in healthcare is really not a long time at all, um, we've gone from.

Point solutions to platform solutions. So the, you know, a point solution for each type of patient or each type of intervention, whether that's like, here's a cardiac rehab solution, here's the total joint solution to like what, basically what we do and what we've always done, which is we can support any type of patient experience.

So interestingly, we went from people saying to us, you're trying to do too much, and now they're telling us we're trying to do too little. Because of this, the ones who see this overall digital patient experience, so they're asking us, how do I attract more patients? How do I, you know, you do, you do a great job of retaining them and recalling them, but how do I find them to begin with?

How do I do some basic triage of them when they're just starting to think that they might need care? And so I think what, what we would do if we were doing today is we'd actually do something even bigger because our customers are asking us for, for that something bigger and the market is ready. I think if I'd come out with like, we're doing a, you know, all of these things that a patient needs to do outside the clinic, we're gonna do them.

If I'd done that like four years ago, people were just like, you're crazy. Um, I don't understand what this is. So I think we would do. Similar, you know, a similar thing, but even bigger. . Yeah. And the thing about platforms, 'cause uh, I've been a part of some platforms in the past, and you really have to do one thing well, and then people go, Hey, you solved this problem for me.

I have this problem. You solved that. Can you solve this? And then you, and that's, that's, I mean, that's how we started that. We, we absolutely had that. And being platform people coming from Microsoft, we saw, oh, If we architect this correctly, there's a lot of repeatability across all of these scenarios. Yep.

And, and to be honest with you, selling a platform is hard because people just go, I don't know, I, I just, they just can't get their arms around it. So th that's a, you know, it's, it's interesting that you'd say you'd start, you'd start differently, but really probably you wouldn't, you'd solve one, one or two problems.

Yeah. If I was, I would say have a platform behind it. Yeah, no, totally. And I, I think if I was gonna only solve one problem today, it might be, it might be getting more patients in the door, because that's what health systems are looking for today. Now that's not the long term. The long term is what is, you know, we be backed by the whole patient, digital, patient experience, multimodal, all of those things.

Yeah. Consum, consumerization of healthcare consumers, patient consumers. That's, uh, it's an interesting challenge that we're having today. Uh, next question. So what would you tell someone who's thinking of getting into the, uh, digital health, uh, uh, entrepreneur game today? So, I actually toyed around with this when I, when I left St.

Joe's and I was gonna, The digital space and I talked to a bunch of people, , and there was, it ranged from don't do it to, uh, to, you know, to race for it. It's gonna be awesome. So what would you, what would you tell somebody? Um, uh, somewhere between those? I would say that you can make a huge difference, but it's gonna take a while.

Um, you know, one of the . One of the things when, when, uh, when we worked at Microsoft, oftentimes, you know, you'd have crazy deadlines and you'd have to ship things. And at a certain point, you know, people would say, look, we're not saving anyone's life here. We can't save that anymore. And, and we love that.

You know, it's like we can, we can save someone's life. We can prevent a, a complication or a remission by catching it early. So I think that with digital health, like you can have such a big impact, um, but you're gonna, you're gonna have to be patient. And you also have to be empathetic and empathetic both to your users, whether those are patients, but also the clinicians.

You know, there's a lot of, um, I think Dave, Dave Chase said once that, um, he's a Seattle entrepreneur who's beating a drum of changing in healthcare, but he said he wants people who want to disrupt from a place of love, um, which is, you know, you have to, like, the, the clinicians are not going away. That they're stuck in a system.

Don't be disdainful of them. Understand the pain that they're feeling. Like I, every time I see these articles about physician burnout from EMRs, I was like, in what other industry is the problem of like, your technology is making you hate your job, like, hate your job. I, I don't that, that should not be the case.

So that the way I say is like, go for it. But you know, you gotta have, you gotta be patient. It's gonna take a long, it's gonna take a while. Disrupt from a place of love. I love that, uh, terminology. Um, if you could pull one policy lever. Oh, wait, wait. I wanted to So you wanna go back? I have one more thing that I, I was saving, which is, um, if you're looking for a new opportunity, I would go back to again, these, all these new organizations that are forming.

Yeah. Um, because there's something there. They're gonna need something. And I think that, you know, one of the, the challenges of value-based care is that the EMRs are not designed. To link outcomes to cost. So I, I don't know if that's the thing to do, but like all these new organizations are gonna need some sort of new technology and I don't know what it's, yeah.

And if, if people didn't know you were from Canada, when you say organization, they'll, they'll know you're from Canada, so, oh, what, why, what, is there an accent there? No organization. It's organization, but there organization. Oh, interesting. Uh, you know, it's, I, I got rid of a lot of my Canadian accent, but there's still a few things, like, and, uh, pro process and process are the, is the other one I say, I say process now when I go to Canada, they don't like it.

All right. Uh, alright, so I'll, I'll put you in a policy standpoint. So if you could pull one policy lever in healthcare. 'cause you know, to be honest with you, this, this, uh, Uh, disdain for technology within healthcare? From the provider standpoint, I'm not sure. I mean, I think there's part to blame on the technology standpoint, but it's really a regulatory and a compliance thing that we have people from afar telling physicians how to practice and how to document and how, and all the things that need to track.

Yeah. Um, so if there's one thing, one policy lever, you could, you could pull what, what, what would that be? Um, well mine would, would be actually around fee for service. I think fee for service needs to be reserved for transactional models like urgent care. So urgent care makes sense. Like, what did you do to this person?

I will pay you for those things. But if you wanna keep people healthy, fee for service doesn't make sense. You know, fee for, you actually wanna potentially do less for them. So that, that's the one that I would like to see. I don't think it needs to go away entirely because you gotta get paid for what you're doing, but it needs to be applied in the right scenario.

Actually, it is interesting 'cause fee for service. I, I feel like they want to do more because they'll get paid more. And the other, I feel like they wanna ration because they get, they get paid a fixed amount. Well, that's, that's the problem. Like, it's like there are some situations where you're gonna do things and you need to get paid for them.

And then there's some things where you actually need to not do things and you need to get paid for not doing things. Right. Yeah. It's, yeah, it's the, the age old problem. I, I'm gonna throw out a bonus question here, just 'cause I'm curious. Your thoughts, you know, big tech, uh, players coming in, doing things.

Amazon, obviously they have, uh, not only their acquisitions, but the J p m Berkshire thing, you, Microsoft, uh, reengaging in healthcare, uh, a couple years ago and, and still moving Google, whatnot, of the big tech health, uh, moves that are going on, who's gonna have the biggest impact? I don't, honestly, I don't know who's gonna have the biggest impact.

Google's taking a lot of Betts, they've got DeepMind, they've got Verily, they've got Onduo. Probably a whole lot of other things. I'm not thinking about the baseline study. Um, so if if even one of those pays off, it'll have a big impact. Um, I think everyone wants to Amazon to have a big impact so that we all get better customer service in healthcare.

Um, but then thinking back to the beginning, I, I don't know that I would rule out China. I think there, we don't know . At least I don't, I'm not paying a lot of attention, but there's, they can do things with a lot less regulatory and they're very incented because of the population and the fact that the government is, you know, needing to provide care for this population.

So I think, you know, it, it's exciting. I love seeing big tech and consumer-focused organizations taking a swing at that. This I agree. Um, but I don't know who's gonna win. I think. We'll, hopefully we'll all win . Yeah, exactly. And I, I think that is the case that, that, that the $6 billion going into the market, these big players coming in, and I think that's just indicative of the fact that.

Uh, you know, it doesn't matter what country you live in, what community you live in. The one thing we all have in common is we want good health. And, and so that ends up being something we're willing to pay for and something we're willing to invest our minds and time into. So, and it just has a great, uh, impact, uh, long-term impact.

So I think people love being a part of it. Um, I, I've loved our conversation. I'm sorry. We, you know, we've, we've almost run out of time here. Um, you know, I, yeah, I do. I do have a question for you. Oh, you do? Okay. Yeah. I know I'm supposed to be asking you questions as we went along, but I, and this is a little.

Uh, like it actually goes back to the, your intro health lyrics, what you guys do. Um, which workloads are you seeing moving to the cloud and then any particular cloud? More than I. Uh, others? Well, you know, that's, that's an interesting question. Uh, to be honest with you, I think, um, Amazon probably has the most mature cloud per se, but I think Microsoft's winning the game and the reason they're winning the game is 'cause it's just a checkbox on a M s A agreement.

So it's, Hey, we're gonna do Azure, and you just check the box and. And away you go. Yeah. Uh, it, it's just easier. And, uh, and the other thing is, over the years, health systems and, and payers, providers have hired so many MIC people in that Microsoft stack, so they're comfortable going from SQL to Azure and, and whatnot.

Um, and it just, I mean, I've had a CIO look at me and go, I, I, I understand the benefits of the Amazon stack. He goes, I just, I, I can't hire those. I in this market. I can't hire those people. Oh, interesting. Um, I heard, I heard someone say that as Amazon's making more moves in healthcare, that's also pushing people towards Microsoft.

Oh, interesting. Well, like same way. Same way that retailers don't want be on a w s maybe I, I mean, which is interesting, but what work, what workloads are, like, what are they doing? Because like we see it as we're an application running on a w s So a W Ss comes in and, you know, they're, they're doing a specific application, but like, what kind of

Processing. Are they they moving? Yeah, so there's, there's, there's, I mean, I'm gonna stay in high level here. So it's two things, right? It's, it's cloud infrastructure and it's cloud data, uh, cloud data models. So cloud infrastructure, you can see, uh, it's a lot easier to get to DevOps, moving to the cloud.

than it is to try to build it yourself. And so that's, that's where we're spending a lot of time right now is saying, look, you're, you're, uh, I hate to talk in these terms, but it's just reality. I mean, right now you're managing your infrastructure with 35 people. When you get to a DevOps environment, that becomes five because you're automating and whatnot.

Yeah. And uh, that's not to say that those people go away. They could do other things. You could take those 30 people and move them to analytics. 'cause we always need more people doing analytics. Yeah. Um, and then cloud data models, uh, again, is just, uh, once we consolidate this data, one of the first things you have to do is you have to bring your data at least close to each other.

Yeah. So that as you're creating these, these platforms that are pulling data from any one of your , 800 different silos of data. Um, it's not traveling as far and whatnot. Right. And, and then you can, um, and quite frankly at that point now you've opened up the world of, uh, AI machine learning, because you're not, you're not gonna build that locally.

You're gonna use Amazon's, Google's, Microsoft's. Right. That's the thought. Great. Thank you. Well, thanks, thanks for giving me that opportunity. I'm gonna, I'm gonna skip my, well, actually I'll, I'll do a quick social media close on this one. So, uh, I just read this, uh, you know, and it has a picture of telephone.

It says, if Twitter was around in the olden days, uh, if Twitter wasn't around in the olden days, why is there a hashtag button on landlines? So anyway, that's what my kids would call a dad joke. Um, that's totally a dad joke. Yep. There you go. So, uh, hey, thanks for coming on the show. Uh, an. What's, uh, is there, is there a good way for people to follow you on, uh, social media?

Uh, I'm at Ann. Well Pepper on, uh, Twitter, so that's probably the easiest thing. And I tweet about healthcare Seattle. Dogs, mountains, flowers, , dogs Mountain. Wow. Uh, that's awesome. So, uh, yeah, so you can follow, you can follow me at the patient c i o. You can, uh, follow, uh, writing on the health lyrics website.

Uh, you can follow the show at, uh, this week in h I t. The website this week in health it.com. Uh, and uh, you can catch our videos on the YouTube channel this week in health it.com/video is the easiest way to get there. Uh, please come back every Friday for news commentary and information from industry influencers.

That's all for now. Thanks Anne. Thanks Bill. Great to talk to you.

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