Month: May 2021

Everyone believes that digital provisioning of care is here to stay.

Season 3: Episode #87

Podcast with Sean Duffy, Co-founder and CEO, Omada Health

"Everyone believes that digital provisioning of care is here to stay."

paddy Hosted by Paddy Padmanabhan
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In this episode, Sean Duffy, Co-founder and CEO of Omada Health discusses their journey as a virtual care company, primarily serving self-insured employers with a focus on supporting chronic disease care. Sean also talks about the thought process behind their newly launched offerings and how they stand against their competitors.

According to Sean, to be successful in digital health, it is important to keep up your learning curve, be patient, and operationally innovate within constraints. Payers, providers, and employer customers all have the same need – digital delivery of care. They all believe that digital provisioning of care is here to stay. This belief is bound to yield a remarkable transformation for healthcare. Take a listen.

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Show Notes

00:41About Omada Health and how the company started.
02:39What kind of enterprises do you mainly serve – payers, providers, employers?
03:53 Omada is a privately held company. Who are your major VC’s and how much the company has raised to date?
06:13 Omada is a pioneer in chronic care management using digital tools. Can you speak about your new services and the thought process behind launching these offerings?
20:04 What is your own view of where we ought to be, maybe 18-24 months from now? What does the hybrid world look like for you?
22:55 We are awash in VC funds at the moment, chasing digital health companies at every stage. What do you make of this abundance of capital and what is your advice to startups?
25:44 Big insurers and employers are beginning to acquire telehealth companies, and we’re also seeing a lot of M&A among digital health startups. What is driving this?
27:41What is your view of the big tech firms and the role they're going to play going forward in how care is delivered in future?
30:24What is your view on where the reimbursement environment is headed today in the market? If there is one thing that you would like the regulators to address, what would that be?

Q. Can you tell us about how you got to start the company and when did you launch it?

Sean: Omada Health is a virtual care company. We specialize in longitudinal disease areas with a particular focus on chronic—those disease areas where you need a lot of longitudinal day-by-day support versus visit-by-visit support. We offer an integrated care suite of services in pre-diabetes, diabetes and hypertension, behavioral health, and musculoskeletal. We think that what digital can do best in healthcare is fill in gaps between visits. The company began as an internal project at IDEO. Prior to this, I was in medical school and was in an MD MBA program at Harvard. I had worked at Google before and between my first and second year in medical school, I took an internship at IDEO and thought I would go right back to medical school. But I sat close to this gentleman, Adrian James, who at that point ran medical products for IDEO. We became best friends. We got a little bit of a time and budget to think about transformational opportunities in digital health, and the result was Omada. Omada was founded in 2011. We just crossed our 10-year mark.

Q. What kind of enterprises do you mainly serve – payers, providers, employers?

Sean: Our primary focus is on self-insured employers. That turns into many relationships with payers as well and we do have many partnerships with providers, especially those who have their own health plans, like Intermountain Health, Kaiser Permanente, etc. Our primary operating model is to go to employers, share our vision on what care can be and how a different approach in the disease areas might benefit their employees, both from a clinical outcome, economic, and satisfaction standpoint. Often, they will see if they could find a way for us to work with their health plan to make the implementation easy and simple. In addition to the employers, we serve many health plan partnerships as well.

Q. Omada is a privately held company. Who are your major VCs and how much has the company raised till date?

Sean: We have raised over two hundred and fifty million dollars to date. It does take a lot of capital to start a healthcare company, and you must ensure that you are doing it in a way that earns the right to commercialize and what many times appropriately, very risk-averse by market. Healthcare is one undertaking that requires capital and enough to get started to the investors that we have. We are honored to have great folks from many, many worlds in the earlier stage side, great firms as venture partners like Andreessen Horowitz, Norwest, and Wellington Rock Springs Capital. On the provider side, we’ve had Kaiser Permanente, Intermountain, Providence invests. On the plan side, Cigna, Humana, Blue Cross Blue Shield of Minnesota. Those folks come from so many different worlds on the moment of convergence that we’re having right now in the US health care system between different disciplines.

Q. Omada is a pioneer in chronic care management using digital tools. Can you speak about your new services and the thought process behind launching these offerings?

Sean: It’s been a really neat moment of transformation and the newest areas – musculoskeletal disorders – was through the acquisition of an incredible company called Physera. The primary reason for expanding it has to do with two things. One, clinically Omada is very interested in disease areas where we think our core capabilities can make a difference and that a digital-first approach is a right approach. Not all, but we can really support people effectively from afar. In most cases, clinically it just felt so clear that there is a huge gap in access and quality and outcomes that digital could help bridge.

Second is the voices of our customers. Every year at our customer summits, we ask our customers what they want Omada to do, how we can serve them better, and what needs they have. We got persistent feedback that they wanted to do more and broaden our offerings to other areas in the benefits to simplify implementation and enrollment. But there is also a lot of clinical comorbidities. So, you can create elegant, coordinated care experiences by having an integrated suite in these critical longitudinal areas.

Q. The mental bandwidth that you need, and the resources and the infrastructure can also be a challenge, especially from a leadership standpoint. Does that, in some sense, distract you from the core mission?

Sean: The guidance that I would provide is that you really want to earn the right to enter new areas, but don’t do it too soon and don’t do it too late. Because it requires a lot of organizational transformation to go from one product line to multiple. It is never a simple journey because you have to rethink how you staff the product organization. You must think about how you train and staff your commercial organization; all the subject matter experts from the clinical team need to become fluent in all these conditioned areas.

Second is what I call selective breadth. So, we are the company that is going to focus on the key needs for our buyers and make sure that within those needs, we’re doing a great job in tying the room together and coordinating all the care between them in an elegant way. But it’s a very heavy undertaking. So, focus is so important for companies as they grow.

Q. From the customer standpoint, they see you as something today and then tomorrow you are a little more than that. You are offering new services when maybe to have existing relationships for those new services. How do you help them make the tradeoffs of the choices, especially as a new entrant into the field?

Sean: Firstly, it’s really important to be flexible. We must be able to support an a-la-carte intention. We share a vision on why all the infrastructure ties nicely together and why it may make sense to deploy more than one kind of program area from Omada. But you must be flexible with configurability, especially in markets where employers may have made some great decisions for them. You must approach it with a sense of humility and really listen to customers and fundamentally work not just to show and describe a potential value prop and why the entire suite in some might be better than the individual parts. Show it in the outcome. Show it in the clinical protocols, the rationale. And then, hopefully, you earn the right to support them in new ways. It is never an either-or, and you do need to remain flexible and true to your original product areas as well.

Q. From a competitive standpoint, one of your big competitors last year, Livongo, was acquired by Teladoc, and trying to offer several different things. What does it mean for a company like Omada Health and how do you see them? Also, what are your thoughts on the competitive landscape where you are?

Sean: First and foremost, we’re in early innings. But if you add up the numbers of people we have helped, about four hundred and fifty thousand in counting. I think for us it’s a little bit more in the prediabetes phase and for Livongo it’s more of type two. I think it was about the same when they sold to Teladoc. But look at the overall disease epidemiology of the metabolic disease. We have done nothing relative to improving the overall health curves and epidemiological curves of the country. So that is a statement on how much room there is to have a lot of players here. If we are taking different approaches in the market, I think both organizations will be hugely successful. We do have a common vision that is integrated care suite can make a difference here. We have our unique approaches and styles, and we are honored to compete with them and hopefully, they feel similarly.

Q. Digital health is having a moment with this billion and billions in venture capital money. They are going through a lot of consolidations. When you look at the marketplace out there, what are the things that you try to keep track of so that you can calibrate your progress against whether you are on the right track or not?

Sean: The number one is what our employers and plans are saying and telling us. My most refreshing and insightful moments are talking to our customers, and talking to our sales reps. We have lived in various walks of industry cycles. It is almost too easy sometimes to get caught up in the excitement of a deal or a merger or financing. I always try to remind our employers that let’s stay just true to serving our customers or members and think how you can do that better and all the rest will follow. If you are not in a position where you can ignore the cacophony and a hype cycle, you are not going to be in a position where you can stay true to your roots. Also, you will not be able to power through a cycle where there’s a critique about the digital health space. This is a multi-decade journey, so hang tight and stay measured and focused on serving customers and members. It’s a very dynamic marketplace and it’s an honor to be serving as an innovator in this moment in the U.S. healthcare system’s transformation because it’s really remarkable time.

Q. What is the one common theme that strikes or stands out that you hear from your employer customers versus your health plan customers versus your providers?

Sean: I think in-person care needs to be option B. Why would you drag someone into a waiting room of a clinic unless you could not solve their needs safely and effectively from afar? You can’t do everything from afar. Like, Omada will not be doing hip surgeries, but there is a lot that you can do remotely. What has happened due to COVID, it’s become an obvious that the digital delivery of care is here to stay. And that is something to be embraced as a fundamental part of the U.S. healthcare system. I think tomorrow’s payers will have network teams that set up networks with digital providers just like they do in network teams that set up networks with in-person providers. For all the stakeholders, it’s very hard now to find either an employer or plan or provider that does not have a digital care strategy that does not think that digital care in the digital provisioning of care is here to stay, and it will yield remarkable transformation.

Q. What is your own view of where we ought to be, maybe 18-24 months from now? What does the hybrid world look like for you? 

Sean: I think what COVID did is it exposed huge opportunity, but also exposed some fissures because you cannot trick yourself into thinking that you can do everything digitally. A lot of my friends are not practicing docs, they are doing asynchronous or synchronous digital, like CareFirst. Think of patients that are in the primary care settings and how many you must send to in-person care, it’s actually a fair amount. So, you cannot accomplish everything afar. Omada is focused on disease areas where we think the bulk of the provisioning of care, the tipping point of 80 percent, can be done from afar safely and effectively. We have learned what does work and does not work, and that’s going to help us get into equilibrium, and it’s going to be a hybrid. I think we will end up in a world where every single health system, it does not matter if you’re UCSF or an independent two-person primary care practice, you will be doing some form of telemedicine – video visits or phone visits. And what is going to happen is companies like Omada will become experts in augmenting the in-person care system and filling in all the gaps. As the operational transformation, the pricing model transformation, the care team, and professional and personnel transformation required to orient toward longitudinal is quite heavy. So, I think some things will be adopted universally at the level of the current provider, and some things will stay in the cloud.

Q. The digital health landscape today has somewhere over 5000 digital health startups in the market, and there is a lot of VC money out there. What is your advice to startups and to VC firms who are getting into the digital space today?

Sean: I think I’d like to see the capital and space have a lot of smart minds run at hard problems and innovate and see what happens. The beautiful thing about the world of entrepreneurship and venture is not all going to work, but some are going to work beautifully. In the U.S. healthcare system, you cannot find a shortcut. You will not be able to disrupt from the side and go around the system like that is impossible, nor should that be the objective. You must learn where the value is, how a dollar flows to the system. You must be able to deal with the complex dynamics of navigating different insurance lines. You must plan a go-to-market strategy almost specific to each state because the state-by-state dynamics are entirely different.

The second is, ramp the learning curve, ask a lot of questions, be OK with that and do not try to judge the system; view it as it is and find a way to operationally innovate within the system constraints.

Q. Big insurers and employers are beginning to acquire telehealth companies, and we are also seeing a lot of M&A among digital health startups. Like Walmart, Cigna, etc., are acquiring companies. What is driving this?

Sean: I think they are listening to the same voices that we hear to. However, Walmart is a little bit different here. In the future, if you are a health plan and serve a self-funded employer, your self-funded employers will need to know what you are doing relative to digital care for their employees. You will then think through the pieces that you want to have in-house fundamentally and bring value to my customers and integrate with my additional services. Also, what are the elements that I want to partner with and find great companies to work with? I think it is an exciting time to be in this space and I love the new entrants. It is fun to watch a Walmart come in to care in different ways. I think Walmart will do extraordinary things to care for the country, as there are many of the plans making bets and innovations here.

Q. Amazon is among the big tech firms a little bit different because they are directly getting into the healthcare space instead of the others who are more about offering the technology enablement to deliver care more efficiently. What is your view of the big tech firms and the role they are going to play going forward in how care is delivered in the future?

Sean: I think what naturally tends to happen is companies end up being excellent at the things that are in the back of their core strengths. Look at Google, for instance, they are the sort of computer science miracles. Their approach to developing incredible machine learning and artificial intelligence models to look at radiological data and help augment clinicians’ interpretations of readings is extraordinary. That sort of deep computer science meets biology work will likely be where Google makes its biggest contributions. On the Amazon side, I think it’s complex, the supply chain and operations. And the acquisition of PillPack in the pharmacy is a great example. And then I put AmazonCare in the same category. It is logistically complex to deliver all care digitally. Amazon has a unique, beautiful approach, listening to the pragmatics of care delivery and recognizing that you need in-person care. Amazon approaches the market with a powerful sense of customer-centricity. They are learning the details and specifics that others have maybe tripped on in the past, and they will be very successful in time. It is not going to happen overnight. But that is a patient business, and that is a business that’s willing to put a lot of capital to work to write out whatever period it takes.

Q. In Telehealth, we have seen some of the waivers come in, not permanent yet, but the hope is that they will be there. We are seeing a shift from traditional payment models like PMPM to slightly different alternatives, emerging models. What is your view on where the reimbursement environment is headed today in the market? If there is one thing that you would like the regulators to address, what would that be?

Sean: My biggest worry is relative to the inability or potential for us to seize the opportunity that COVID presented to transform healthcare. Suddenly, we are doing fee-for-service through video, and we call that success at the end of the day. It is great that clinicians can now do video visit or a phone visit, but that is not the end state. Allowing flexibility in service models can accommodate either synchronous interactions or asynchronous interactions. So, people sometimes forget that a lot of care preference at the consumer’s hands might be the kind of text they email to their care professional. So, they ask for Medicare and regulators to open minds to ways to thoughtfully accommodate. Asynchronous building models and there is a way to do it, you can think through like a care episode where once it starts over 15 days, a clinician is allowed to interact in whatever way possible. Think of it as Medicare Advantage and ask that we align with the scope of services we provide. We have a monthly rate that we charge for providing that, and it includes devices, your primary coach or certified diabetes educator, your nurse or all the services we render inside that. But we retain the flexibility to personalize against the need.

About our guest

SeanDuffy-profile

Sean Duffy is the Co-founder and CEO of Omada Health, a digital health program that combines the latest clinical protocols with breakthrough behavior science to make it possible for people with chronic conditions to achieve long term improvements in their health

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

With innovation, you need to be prepared to recognize that every idea is not a great idea.

Season 3: Episode #86

Podcast with John Donohue, Vice President of Entity Services, Penn Medicine

"With innovation, you need to be prepared to recognize that every idea is not a great idea."

paddy Hosted by Paddy Padmanabhan
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In this episode, John Donohue, Vice President of Entity Services at Penn Medicine talks about their 6-years long, $1.5 billion investment in a hospital of the future to be launched by the health system in their West Philadelphia campus. The hospital features new interactive technology for improving patient care and Disney-inspired user experience design.

John discusses a range of other topics, from defending against the ever-growing cybersecurity threats to finding success with technology partnerships. Their “3C” mantra for technology enablement in care delivery – common systems, centrally managed, and collaboratively implemented – has been a key to their success over time.

John also provides practical advice for digital health startups looking to partner with Penn Medicine in launching innovative solutions. Take a listen.

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Show Notes

05:50About Penn Medicine’s new hospital facility – The Pavilion.
10:16Brief about the new facility’s design process.
11:10 How long did it take to design the new facility, the patient room of the future?
12:53 How do you ensure that you have adequate security, data, security, and patient privacy? What additional considerations went into this when you were putting the design together?
15:47 How have you laid a data and analytics layer on top of this infrastructure?
17:11 Are you leveraging the cloud to post your applications infrastructure, especially for this new facility and even more specifically for the data?
20:38 Moving things to the cloud may sometimes end up costing you more if you're not careful. Can you comment on that?
21:29Interoperability has been a work in progress for healthcare. How would you describe its State of the Union across all of your applications in your landscape?
24:25Most health systems try to consolidate all the applications into their core platforms. But on the other hand, they also have to be open to bringing on new innovative solutions. How do you manage this?
26:36What advice do you have for startups that have something interesting to say and want an audience?
28:04A best practice you would like to share with your peers in the industry for someone embarking on a journey to make a billion-dollar investment in a new hospital.

Q. John, what does your title mean in terms of the areas of responsibility for your role? Can you describe the applications landscape as well? 

John: I have worn many hats in the 12 years at Penn Medicine for a long time. I was the infrastructure executive responsible for enterprise infrastructure, component data centers, networks, telephony, video services, storage, et cetera. My role there was focused on resiliency and availability, which is critical in any academic health system where I built the information security team. We went from about four employees to about thirty-two dedicated security professionals in less than four years. However, my focus for the last couple of years has been around what we call entity services, and we refer to as entities, hospitals, and other major functions. Today, we have 13 of those today, six inpatient hospitals, several other areas like primary care physicians, specialist providers, home care, school medicine, et cetera. Each of those entities has an Information Officer and Information Entity Officer. So, the entity services team is comprised of about two hundred people across Penn medicine, delivering services like clinical engineering, platform support, network support. They have just been designed to allow the entities to have some autonomy regarding their priorities and resourcing their needs. My role has been for about ten years now and is part of our special sauce, making our information services team successful. It has personally brought me closer to what we do as an organization in providing world-class healthcare. Many of the different hats across the last several years have given me a unique perspective around what it takes to run a large-scale organization in an academic health system.

Our primary application is Epic or what we have started calling PennChart. We started installing Epic probably twenty years ago in the ambulatory setting. About six years ago we migrated to Epic on the inpatient side of things and have since installed many of their specialty modules, like Uptime for the OR, Cupid for cardiology. We also leverage several of their mobile platforms with tools like Haiku and Rover. Epic customers will be familiar with those terms and we use Epic tools that allow us to work with other physician practices in hospitals, things like what they call “healthy planet” care everywhere community connect. We also leverage some of their modules for the data analytics-based tools. Lastly, we use their patient portal for facilitating communications with our patient population for things like appointment scheduling, test results and medications. 

Q. You are about to launch a new hospital which I believe is going to be the hospital of the future. A lot of new technology enablement aspects are going to make for an interesting and improved experience for people. Can you talk about that? 

John: It is an incredibly exciting project and by far the biggest one I’ve ever worked on in my thirty-five-year career. I think it is the biggest capital project in the history of Penn, which goes back about two hundred and fifty-plus years. Our first meeting on this topic was over seven years ago, and we are set up to be patient-ready by the October-November timeframe this year. It is in our West Philadelphia campus, across the street from the hospital of the University of Pennsylvania and the new building. It’s a $1.5 billion investment that includes about 1.5 million square feet, 500 state-of-the-art private patient rooms, 47 state-of-the-art operating rooms in this 17-floor facility. This innovative hospital facility is designed to support our world-class researchers, clinicians, and faculty. It is trying to create a stage for these world-class folks to do what they do best.

From an IT perspective, we view this as an opportunity to significantly improve our patients’ and our providers’ engagement with technology. We have designed the building to support a fully digital experience with Wi-Fi and cellular coverage throughout the facility and have developed what we call the patient footwall, which has really been around designing the integration of several different technologies that will make the patient stay more comfortable. The technology will also enable providers to engage with the patients during their stay. The hospital will be 5G ready, aggregating nurse call and nursing alerts to a mobile app to reduce nursing fatigue. At the center of this will be a seventy-five-inch TV, a centerpiece for education and entertainment for the patient. A tablet in the room will allow patients to manage the room, the temperature, the shades for lighting, noise levels, privacy, potentially ordering dietary requirements, full integration with our electronic health records. As soon as staff enters the room, the patients will know who they are, their role, and potentially why they’re there. All the environmentally friendly components in the facility will help us be responsible from an environmental perspective and reduce some costs. The common theme for us with this Pavilion on the campus is connectivity. The need to have a patient care facility like this with advanced connectivity is fairly evident. When you think about extending this connectivity beyond just IT and creating a seamless patient experience across the campus with transitions of care, you’re talking about some game-changing improvements in patient engagement.

We’re there to take care of the patients and their needs and focus on them. The intent was to have a highly private facility for our patients that would be comfortable for them and their family members and make it a good experience and have the room outfitted so that it does feel like an improved patient experience. We intend to provide a hospitality experience. We talked to Disney and others so that we could work them into our design.

Q. The tech can doeverything but developing this unique and differentiated experience requires a whole different level of understanding of human needs. Can you talk about design process to design the experience carefully? Also, how long did it take you to design this patient room of the future?

John: We brought in subject matter experts from architecture and design from across the globe. And then built out a half a floor in a warehouse out of Styrofoam, brought in time emotion studies, and made some significant changes to our original design based on actual people, wheeling gurneys through these Styrofoam hallways. We looked at access and traffic patterns and did all kinds of timing exercises of how long it would take to get somebody from the ED to an OR. As fun as the technology was, if you design and implement it right, it’s right. Getting it right from a design perspective is a whole other level and I think we knocked it out of the park. 

It almost took three and a half to four years to design the room from start to finish. We found some slick ways of a nurse sitting at a desk outside of the patient room like we mirrored the patient room such that a nurse could monitor two patients at the same time through these windows. We have done some innovative things in the bathroom and the shower design and brought those in these units by leveraging the city’s views. It was an extensive design process. We have also designed flexibilities into the room to be used for many different purposes. In the old days, you had your normal patient care rooms and then you had specialty rooms. These rooms are all designed with booms to move patients and capabilities that can become more specialized on the change of a dime. Over 500 rooms in this net new building are designed and set up in this way.

Q. How do you ensure that you have adequate security, data, security,and patient privacy? What additional considerations went into this when you were putting the design together?

John: If you think about this patient room, many components are of the Internet of things. Whether it’s the lights or the devices in the room that are more typical Internet of Things type devices, everything that sits on the network poses a potential concern. So, we teamed up with several subject matter expert partners. We set up a lab environment and implemented all this technology in the lab. If you walked into this lab, it would almost look like the patient room to you. We rolled in the monitoring equipment and everything else to be really a good mirror of what would be happening in the new Pavilion itself. Then we made sure that we had the security we were looking for in that room. We did some exercises to try to tap into the network through some of these devices and asked our vendors to work in their labs at their own manufacturing plants. The technology that we have integrated and the standard tools we put in place to manage security across the enterprise is in pretty good shape. But in this business, you need to be vigilant. The threat landscape changes dramatically over time. Health care organizations have really become the focus of cyber-attacks over the last several years. It started with medical records being more valuable to criminals than credit cards and has only been exacerbated with organizations like ourselves that are in the center of COVID research and vaccine distribution. Patient privacy and ensuring that we’re a secure organization are really important to us, so we have redoubled our efforts with this new facility to ensure that we’re in good shape. Devices like network segmentation, network access controls, building profiles can change their behavior; we have a chance to isolate them and pull them off the network in case they could have been hacked or breached and could be a vulnerability. We are making sure that new Pavilion and the rest of our enterprise is secure.

Q. You have a ton of data that’s going to be available by observing the way these devices and the software of the services used by patients or caregivers and how the devices interact with one another. Can you talk about how you’ve laid a data and analytics layer on top of this infrastructure? 

John: We started to make investments in our data analytics group from the last three years and have continued to make those investments. With this additional information, we will focus on how we turn that into knowledge, with that data, people can make informed decisions. So, we have matured our efforts on the data analytics side, but we are still trying to identify the best way to use all this data. We are excited by the opportunities and looking at how to make future investments in this informatics to make sure we’re leveraging all this information. Through this data, we make sure our clinicians and executives are aware of what’s available and then optimize it based on that information.

Q. Are you leveraging the cloud in any significant way either for posting your applications infrastructure, especially for this new facility, and for the data?

John: I call our cloud strategy – opportunistic. From a Gartner perspective, what they call a fast follower. Cloud technology is not new by any stretch, but we need to make sure that we have business associate agreements in place with the cloud vendors. We spent a significant amount of time building out our private cloud capabilities using hyper-converged capabilities. We have seen some great efficiencies there and been able to move a significant amount of our workload from different vendors, storage and platforms that are computing. Our focus has been on the HIPAA conversion private cloud. We have also been leveraging SAS applications wherever possible. Many of our applications are cloud based in addition to things like Office 365. We’ve made some investments in the infrastructure applications, but we know that in a long-term perspective, we need to leverage private cloud, public cloud, hybrid clouds so that in any time of the day we can move our enterprise workload to the least cost and in the most secure environment. We continue to work with Azures and the Googles and others out there to make sure that we’ve got the right agreements in place. We have got a rather large high-performance computing that’s used on the Research and School of Medicine side that we’re looking to move to a cloud environment. We don’t drive things to the cloud just to drive things to the cloud. We do when technologies at the end of its life where there is an opportunity to be more efficient. I would say today we probably have close to eighty five percent of our workload in some type of a cloud environment. 

Q. So, over time you have moved a significant amount of enterprise workloads to the cloud. But you look at everything on a case-by-case basis and it’s not a default decision to just drop something into the cloud just because that is where you want it all to be in future. How do you do the tradeoffs?

John: We look at the workload itself and look at what kind of data is on those workloads and then what we’re doing today. If it’s in a hosted environment that we’ve outsourced, we look at what’s the cost of that environment, what are the pros and cons of running it in that environment, speed to market, the way they secure their environment, and so on. We look at it from a cost benefit standpoint and start to check what are the things that would make us more responsive, more agile to get things time to market. We also look at the ways that can take our resources and focus them where we want them to be focused versus running our own data centers and setting up servers and managing the servers and storage. We look really at return on investment and risks.

Q. I have heard often that moving things to the cloud may end upcosting you more if you’re not careful. Can you comment on the ROI part of it? 

John: I think we found the same thing, particularly with our high-performance computing capabilities. It looked attractive on the surface, but the devil is in the details. Once you start to pick up things and move it over, you learn quickly that there’s some hidden costs. There are times where you’ll accept those costs because it reduces investments and resources that you need in other places. But we have learned the hard way that sometimes the cloud is actually more expensive.

Q. How would you describe the State of the Union as it relates to interoperability across all your applications in your landscape?

John: We have taken a three C approach to applications that stands for – common systems, centrally managed, and collaboratively implemented. It is one of the mantras we use in IS, and it’s been key to our success over time. In the last 10 years, we migrated many small applications into these large suites that I talked about earlier, like Epic. It’s allowed us to be efficient in our spending and resources and drive a lot of cost out of the system. As we look at integration or our ability with new applications, we lean on those standard systems first. And then see if they can work for us versus adding in a new best-of-breed type of application. 

Secondly, the legacy there is centrally managed. So, pulling everybody together into a corporate IT organization has allowed us to eliminate most of the shadow IT in some organizations. Shadow IT resources are the ones that in many cases introduce new applications that are hard to integrate or hard to interoperate. Between those two things, we’ve built a pretty effective corporate organization that can deliver the standard solutions fairly quickly and economically. 

The last C, which stands for collaboratively implemented, is our secret sauce. We have business projects that involve technology which means that both IT and the operational folks are at the table with skin in the game. This has really delivered very good results for us, because as things start to go wrong, we lean heavily on each other to make sure that we get good results. This strategy has really helped us eliminate overhead and eliminate the need to integrate and interoperate platforms that may be a challenge. 

Q. Most health systems try to consolidate all the applications into their core platforms. But on the other hand, they also must be open to bringing on new innovative solutions. How do you manage this?

John: On the one hand you must keep your network and clinical systems up and running twenty-four by seven. That requires a certain strategy, mindset, and skill. It’s not an easy job but getting there on time takes some work and focus. At the same time, you must have an innovative mindset to stay ahead and leverage these new capabilities. This requires a whole different strategy, mindset and skillsets. Leading teams that are responsible for both can be a challenge today. With innovation, we feel like you need to be prepared to recognize that every idea is not a great idea and failing fast if you are not going to be a winner. But our environment, where a learning organization, we see many entrepreneurs on campus, comes out of Warton, other schools, and is incredibly bright. We have a place on campus that is called Pennovation – a lab space. Their tagline is ‘where ideas go to work,’ which encourages people to come to Penn to do innovative work and to do emerging technology work. So, we often see people knocking on our door saying, “We work for Penn or we graduated from Penn, and now we’re part of a startup. So, we see a lot of these technologies. And I would say one out of every 10 to 12 has got some real value here. It is addressing a pain point that we have, and it’s something that we can’t go to one of our established partners and ask for the capability. So, we have set up a new technology review board that looks at all these and uses a governance process to ensure that we are fair and consistent. So, not only do you need to keep your legacy applications up and running, but you need to stay focused on innovation where it can be a game-changer for you as an organization.

Q. What is the advice you have for startups across the country that have something interesting to say and want an audience? 

John: I think there are two things. One is timing. You must have robust technology that is ready for prime time. People knock on our door many times, and it’s a concept and we don’t have the cycles with everything else we have going on to work through the concept and spend those kinds of cycles there. Timing is key and it’s got to be close to being ready. Another essential part is finding an internal sponsor, a champion, somebody who is willing to be the representative internally around that technology and speak to its benefits. Look at the cost benefits, ROI, and a partner who will help design functionality and capabilities. Also, find the sponsor, the internal person that can champion that.

Q. Is there a best practice that you would like to share with your peers in the industry? 

John: The best practice is to engage with others. What we learned with the Pavilion was that looking outward was a game-changer for us. This sounds simplistic, but we have brought to the table several technology partners and several integration partners and said – “we want you to partner with us and do development on your dime and later you’re going to be able to talk about how you partnered with us.” Getting the right spirit of partnership and getting the right ability has been a game-changer for us. The best practice for us was as big as we are and as talented as the people we have, both on the IT and clinical sides, partner with folks that has significant resources themselves.

About our guest

John-Donohue-profilepic-may2021

John P. Donohue is the Vice President of Entity Services at Penn Medicine, Information Services. John is responsible for leading the Entity Services group; which includes a number of seasoned technology executives, as well as the onsite teams that support Penn Medicine’s many entities. These entity technology groups are responsible for managing the business and facilitating the technology relationship between Operations and Information Services. Each entity group is comprised of an Entity Information Officer and resources that support clinical engineering, platform, and network technology at the entities. Additionally, John is the IS executive driving technology innovation for the construction of the new patient pavilion project, which is expected to open in late 2021.

Mr. Donohue is a seasoned health care IT Executive with over 30 years of experience which includes: extensive senior executive and customer interaction, understanding complex business requirements, identifying technology solutions, developing and executing IT strategic plans. He is recognized as a proactive leader who builds and develops high performance teams that are committed to excellence in the delivery of IT services and solutions.

Prior to joining Penn Medicine, John held IT vice president roles at both Covance (a $4 billion Clinical Research Organization) and Children’s Hospital of Philadelphia (Number one ranked Pediatric Hospital in the country). John holds a BS in Business Management from University of Phoenix.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

We must utilize AI to change the way healthcare is delivered and how patients can be more engaged in their care

Season 3: Episode #85

Podcast with Sachin Patel, Chief Executive Officer, Apixio

"We must utilize AI to change the way healthcare is delivered and how patients can be more engaged in their care"

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In this episode, Sachin Patel, Chief Executive Officer of Apixio, discusses how data science can help solve critical healthcare problems and empower individuals, providers, and health plans with reliable, actionable intelligence. Apixio is a healthcare AI analytics company that was recently acquired by Centene Corporation.

Today, more than 1.2 billion clinical documents are generated each year in the U.S., but there is very little analysis of the unstructured information. The Apixio platform uses advanced analytics to generate insights from unstructured data to deliver significant improvements in financial performance.

Sachin also discusses the big opportunity areas in AI today and the challenges in increasing adoption levels for AI in healthcare. Take a listen.

Our Podcast Partners:    

Show Notes

04:20Where do you see AI in healthcare today, and what are the big opportunity areas?
07:48Your products are focused mainly on administrative efficiencies, specifically revenue and payment operations. How do these solutions create value?
15:59 Recently, several emerging data partnerships have been announced – Truveta, Mayo Clinic, Highmark-ChristianaCare. What are your thoughts on this trend?
18:40 Does your relationship with Centene preclude you from doing business with their competitors? How do you manage any concerns that may arise from other clients in this regard?
19:44 What are the big challenges for AI that the healthcare industry needs to address before we can realize its full potential?

Q. Can you brief us about Apixio and your interesting journey to how you got here?

Sachin: At Apixio, our mantra has always been to achieve better healthcare through data insights. Apixio has created a proprietary artificial intelligence platform that’s able to render computable data from clinical, administrative and other notes. The text in these documents, the unstructured data, contain 70 to 80 percent of the information about an individual’s healthcare, most of which is not captured in claims or other administrative data. Certainly, you need both pieces, the structured and the unstructured data. We pride ourselves on being able to tackle both of those. What we can do with that data is assemble patient phenotypes from the smart aggregation of various insights that are generated from the two data types. Our artificial intelligence platform can then provide these insights for a variety of different use cases which we can get into.

Prior to Apixio, I was with a healthcare services company and the value-based care space, and prior to that I was in investment banking, a way back when I started my career as an engineer.

Q. Apixio was acquired by Centene late last year. Can you brief us about that?

Sachin: Centene had been a recent customer of ours. They acquired WellCare, who was one of our key customers and they had seen the direction that we were taking our platform and the potential that we had – to use the artificial intelligence capabilities, to improve value-based care, and other activities that are important to a health plan. That was a perfect fit for our next chapter. And importantly, we have had the benefit of having seen 40 plus other customers data inform the quality of our insights that are gathered. Now we have access through Centene to twenty-five million patients’ worth of additional data from which to train our algorithms and develop new capabilities.

Q. Centene is one of the largest health insurance companies in the country with a specific focus on the Medicaid population. Is that right?

Sachin: That’s right. They’re largely focused on Medicaid, but with the acquisition of WellCare they have a pretty significant footprint in terms of number of lives covered in the Medicare space as well.

Q. Where do you see AI in healthcare today and what are the big opportunity areas.

Sachin: In the last handful of months and the last few years, a tremendous amount of buildup in different organizations, plans, providers, analytics firms are utilizing AI to change the way in which healthcare is delivered and how patients can be more engaged in their care. That’s really where the sizzle or the interest lies in any company pursuing their activities within the healthcare realm. So, getting closer to that point of care, getting closer to the patient, that’s where you can really drive some of the changes that are being looked for. But you can’t leave behind the administrative or the plan administration side of it as well that sometimes doesn’t get talked about much. The ability to have a technology platform that works across all those areas and be effective in terms of the access to the data, the analysis that you conduct on it, and mining all of the different pieces of information to form a holistic view of what that care journey looks like for both the payer and the provider. And to the patient as well, as that is how you unlock all of the value. The big opportunity lies is bringing that all together. So, you have got certainly a continuum of folks that operate in different parts, but you want to be able to bring that all together and then have that bear out in the type of care that’s delivered.

Q. The money that’s being made today from applying AI directly seems to be a lot more in the administrative functions where you can see a very direct correlation between what you put in and what you get out of it. Is that right?

Sachin: I think that is spot on. Certainly, with appropriate focus on where we all would like to see healthcare go as it relates to the provider and the patient side of it. No doubt that is where we all want to see improvement. Because if you think about what is caused a lot of the abrasion within healthcare delivery in the US, it’s the burden of those administrative activities that prevent the providers from being able to provide the right type of care. So, we all have an eye towards that. But as it relates to where you also need to have important business focus, it is on that administrative side. And I would say you’re right, certainly in terms of being able to demonstrate a clear ROI and then importantly, as you think about value based care and how those contracts are structured and how you drive the action that is desired from all parties to that set of activities, that’s where you want to make sure that you’ve got the administrative software as well, with the benefit of efficiencies gained from artificial intelligence platforms or other technologies, especially when you look outside of Medicare Advantage and think of the other lines of business that typically don’t have as robust a margin profile.

Q. Tell us how Apixio is bringing about some of these improvements in administrative efficiencies by applying AI in the context of revenue and payment operations.

Sachin: In simple terms, if you’re looking at a series of hundreds of pages of a patient’s chart and you’re a human, let’s make it this area that we’re talking about and particularly our primary use cases within risk adjustment activities. If you’re looking at hundreds of pages of charts for thousands of patients over the course of months, you’re likely to get tired, fatigued, very naturally. It might miss a detail or make a decision that may be as inconsistent with a decision you might have made around two weeks prior with the AI platform. AI type capabilities can allow you to, instead of looking at all 200 pages in this document, see eight pages that matter for what you are trying to do in this activity. It doesn’t have to be a risk assessment, could be anything. It could be a quality initiative and a variety of other activities. And if you’re only looking at those pages and you’re generally guided there and making either a confirmatory decision or you’re saying, ‘hey, actually, I don’t agree, because for our plan X, Y and Z matters a little bit more for whatever that uses.’ You can then make that change and being a lot more efficient with your time. And that’s really where I think you gain those efficiency of scale. Also, if you’re only looking at claims data, you may find 20 to 30 % of the information that’s really rich data. It is the record of truth as it relates to payment. When you think further down into other areas where you would want to expand those capabilities, as we were talking about, point of care, clinical discovery, things of that nature, that’s where you do want to look at the unstructured data. That unstructured data certainly has important details, but also has a richness of data and depth of data from the physician’s notes. So, the physician may code at a certain level and say that I have these two conditions, but they may also add in their notes because they don’t necessarily want a bill for that. But the patient also has these other symptoms that we may want to keep track of. That’s what you also want to know and so that’s where we think the entire profile is important, especially as we talk about things like value-based care.

Q. So, from what you have described, you are primarily talking about natural language processing, is that right?

Sachin: That’s part of it and then there are other techniques as well that can be used to combine for insights.

Q. Did you build the technology on your own? Can you brief us about the evolution of the technology and how you got it to where it is today?

Sachin: Yes, we did build everything. It was purpose-built and was in-house for risk adjustment initially. Certainly, we have used a variety of NLP and machine learning techniques. Think about our platform as it has a core capability of being able to find these insights. You can tune the algorithms to find what it is that you are looking for in a chart. It does not have to be this risk adjustment case. I can then tune those algorithms to find other information, whether it’s a quality initiative. I just want to maybe search in a simple way for all diabetes patients who have had an eye exam or something else. You can do all of those activities by upfront, tuning the platform to run those different use cases. That’s really the way in which we envisioned it. So, think of it as there is this base layer of capability and then on top of that, you build out different applications for different use cases. So, as it relates to risk adjustment, an important area for us to select, certainly because there’s a tangible benefit that folk see right up front in terms of being able to appropriately deliver care for what may be a more higher acuity patient population. It also gave us the richness of data over time. We noticed this after we crossed 10 million patient records from across the U.S. and now we’re worth of 20 million. This diversity of data in the risk adjustment function allows you to have confidence in a narrow confidence interval, in the insights that you’re delivering. That’s really important because you’re going to not only believe in the decision that you’re making as a health plan, but you also want to believe in those decisions being made as a provider to ultimately drive adoption of these technologies.

Q. What you’re really talking about is being compensated for the care that you provide and more specifically making sure you’re not leaving money on the table by missing something in the coding process that could be a legitimate claim for a payment. Is it a fair statement?

Sachin: That’s correct. On the other side of it, one of our important full solution capabilities from a compliance standpoint, you also want to look through and review those same charts and make sure you haven’t previously submitted something that shouldn’t have been. In that case you can proactively flag and note it so that payment is essentially recouped or taken out from what you may be finding for other more higher acuity populations. So, it’s important to do both activities.

Q. So, one of your clients, Centene, puts in a dollar of investment in this technology. What can they expect to get out of it in terms of order of magnitude of returns?

Sachin: So, I think typically from an efficiency of workflow standpoint, customers would typically look for is something in the 4-7 times return in terms of efficiency, of effort, of what’s being done by their folks. And from a dollar perspective, it’s a wide range and it depends on what the initiatives you’re doing. I am not speaking broader to some of the other things that we work on with customers beyond risk adjustment, that can vary a little bit more.

Q. Recently, several emerging data partnerships have been announced – Truveta, Mayo Clinic, Highmark-ChristianaCare. What are your thoughts on this trend?

Sachin: In the last handful of months, I think most of the health systems have come to the realization that the path for them is to have a partner that can help them get there faster rather than perhaps developing the capability in-house. The challenge through all of this is going to be how do you keep that data integrity at a high level? There’s certainly some compliance type of steps that need to be held there, especially as it relates to HIPAA. But if you can clear all of that, then you’ve got high integrity of data and then you need to very specifically define what is the success for this activity that we’re pursuing. I think that is generally alluded to in some of the partnerships that you’re referencing and grow into it over time so that you have confidence that the decisions that you’re making, using those technologies are ones that you can feel really good about. They are not going to either impact you from a financial viability standpoint, but more importantly, that are going to be good decisions for you in delivering care for patients. In one of the organizations that you mentioned, the Mayo Clinic in particular, they referenced that they’re going to be utilizing some of these wearables, technologies and other types of data. I think that’s really exciting and interesting.

Q. One of the things that we see when it comes to applying AI in the context of clinical outcomes, algorithms require a lot of retraining. All the variables need to be adjusted when you are moving from one population to another. So, if you have an NLP algorithm that can scroll through charts and surface opportunity areas, it’ll work just the same in any hospital, any health plan across the country, you don’t really have to do a lot of tweaking to it. Is that a fair statement?

Sachin: It depends. Certainly, there’s different guidelines for each type of organization that you’re working with, plan or provider group that might matter to how you approach each situation. So, there might be custom tuning, but as a general concept, your comment is fair.

Q. You’re a part of Centene now and I guess it is a whole different feel from being a native company. Does your relationship with Centene preclude you from doing any kind of business, especially with their competitors?

Sachin: No, it does not. That is the short answer. So, part of the focus of this transaction, and in particular one of Centene underlying thesis, was that we would continue to sell externally and focus our efforts equally there. The simplest way to do how Optum operates within United in serving both the parent company as well as the broader market. So, we continue to work in that regard to win and have won new contracts with other players in the market.

Q. What are the big challenges for AI that the healthcare industry needs to address before we can realize its full potential?

Sachin: I think there is the widespread adoption or the way in which you drive this fast or appropriately with what are the privacy requirements and what is covered under HIPAA and what other considerations do you need to be aware of? There are other government task forces around this that need to be kept in mind. So, it’s the appropriate attention of how fast technology firms would want to move to say – ‘yeah, give me all the data and I’ll run it through, and we’ll get you that much more high-quality insights and analytics.’ But on the other side, you have to move at the right speed. I would say that the ability to get there should be picking up pace as you start getting folks comfortable that you are able to maintain the integrity and security of the data. That happens with more and more players now. Sometimes a big situation that comes up at some point in the future and there’s a breach. Someone is exposed and that becomes a concern. So, with more firms being focused on that as a table stakes item to be successful in winning new engagements with plans and providers, I think it drives some of the discipline even more so around that. When you think about the different axes of how you propagate or become competitive in healthcare analytics with the use of AI, there are three different vectors: there’s the quality of your data science, which you have general control over; there’s the quality of data volume or the quantity of data volume. This is when you have enough diversity of patient data from which to feel comfortable, or can certainly say – ‘hey, for this case, I don’t want to have too much of a bias in this direction or that direction.’ And then there’s the data liquidity piece and it’s really the data liquidity that’s going to be a rate-limiting factor here when you think about those three vectors, because that is driven by not only decisions by health systems and providers, but also from a regulatory standpoint.

About our guest

Sachin-patel-profilepic1

Sachin brings broad experience across both healthcare and technology, spanning a variety of leadership roles, including operations, finance, and development. Sachin joined Apixio in 2017 as Chief Financial Officer and later served as President and Chief Financial Officer before taking his current role. Sachin has extensive experience working with value-based care provider groups including Vantage Oncology, a national leader in community oncology, where he served as Vice President, Finance, and Chief Financial Officer of Vantage Cancer Care Network, an innovative model for managing cancer populations.

Sachin has also held positions with Citigroup Investment Banking and began his career in engineering roles with Cisco and IBM. Sachin holds a BS in Electrical Engineering from The University of Texas at Austin and an MBA from the UCLA Anderson School of Management.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

Medical records must become a living record that pulls in data real-time, follows your health, and displays it back to a physician in a useful form

Season 3: Episode #84

Podcast with Grace Kitzmiller, AWS and
Dr. Michael Snyder, Stanford University’s School of Medicine

"Medical records must become a living record that pulls in data real-time, follows your health, and displays it back to a physician in a useful form."

paddy Hosted by Paddy Padmanabhan
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In this episode, Grace Kitzmiller of AWS and Dr. Michael Snyder of Stanford University’s School of Medicine discuss AWS’ Diagnostic Development Initiative (DDI), a two-year, $20 million commitment that uses cloud computing to scale up diagnostic innovations.

In the wake of the pandemic, Stanford University School of Medicine’s Healthcare Innovation Lab developed a smartwatch-enabled alarm system powered by AWS cloud, designed for early detection of COVID-19 by identifying increased heart rates prior to the infection. Dr. Snyder explains how the application works by pulling heart rate information from the smartwatch, applying an early detection algorithm, and pushes back the signal to a smartphone to set off alerts for possible infections.

Grace shares three gaps that AWS strives to address through the Diagnostic Development Initiative: accurate detection, reprioritization of diagnostic research, and scaling up computing power for machine learning and analytics. Take a listen.

Note: Those interested in participating in the Stanford COVID-19 wearables study can sign up here.

Developers interested in the AWS Diagnostic Development Initiative program can apply here.

Our Podcast Partners:    

Show Notes

02:42What are the gaps AWS is looking to address with the Diagnostic Development Initiative?
04:49About Stanford’s smartwatch-based diagnostic app for COVID-19 detection alerts.
08:16 What has been the predictive power of these smartwatch-based diagnostic algorithms and how they hold up across populations or regions?
12:27 How do the wearable device integrate with Epic or Cerner and make it a part of the longitudinal patient record for diagnostic and treatment on an ongoing basis?
14:58 What about patient privacy? Even in the research phases you're putting some guardrails on what happens to the data. How is Stanford protecting patient’s data?
17:33What has been the response so far for AWS’ Diagnostic Development Initiative? What kind of research projects are we likely to see, with a focus on healthcare?

Q. Dr. Snyder, can you tell us about your role at Stanford?

Dr. Snyder: I am Professor and Chair of Genetics at Stanford University’s School of Medicine. I also run the Center for Genomics and Personalized Medicine, the innovation lab there, and we do a lot with big data in health.

Q. Grace, can you brief us on your role?

Grace: Paddy, I lead Solutions Development for the AWS Disaster Response Program, which focuses on how technology and the cloud can assist organizations that are active across crisis such as the COVID-19 pandemic or across the lifecycle of natural disasters.

Q. Amazon has recently been in the news for several healthcare-related initiatives, and one of them was the Diagnostic Development Initiative. It was targeting COVID-19. Grace, what was the gap or need that AWS was looking to address with this initiative?

Grace: AWS Diagnostic Development Initiative is a 20-million-dollar commitment that we made last year to support customers and accelerate their diagnostic innovations. We provided this support in the form of both cloud computing credits and technical support from AWS experts like our solution architects and our AWS professional services team. These AWS experts helped those organizations that were part of the Diagnostic Development Initiative to use AWS services to either stand up or scale their COVID-19 diagnostics projects. As COVID began rapidly spreading around the world, there were a few reasons diagnostics really bubbled up to the top. First, accurate detection is the tip of the spear for any effective pandemic response strategy. Secondly, diagnostics research has historically been underfunded and largely de-prioritized when compared to vaccine or treatment development. But realistically and thirdly, organizations working on diagnostics also need access to reliable and scalable compute power, which AWS could deliver along with things like analytics and machine learning to help researchers process and analyze some of those large datasets that were being generated and iterate more quickly. So, in the first year of the program, we have been excited and seen some inspirational results from customers like the wearables work that Dr. Synder’s research team is doing at Stanford. It’s really been great to see how these projects are pushing the boundaries of diagnostic innovation. 

Q. Dr. Snyder, Stanford has been one of the early participants in the program. And you have launched a smartwatch-based diagnostic app for the COVID alerts. Can you tell us about the app and some of the results that you have seen so far?

Dr. Snyder: Several years before we found that you could tell when people are getting ill from Lyme disease, as well as respiratory viral infections using a smartwatch. When the pandemic came along a little over a year ago, with Amazon’s help we have really been able to scale this thing up. So, we first showed that we could detect COVID with a smartwatch. It turns out, on average, four days before symptoms and for some people, as much as 10 days before symptoms, we can see when they are getting ill because their heart rate jumps up on a smartwatch. So, we first showed you could do that and recently, we have rolled out this app that alerts people when their heart rate jumps up, which does happen before you get ill with COVID or other things. It can happen with other lifestyle events as well, for example, you drink way too much. But it certainly seems to work for infectious disease about 73% of the time, according to our latest work. It is a simple app that you download on your smartphone that integrates with the smartwatch. It works for Fitbit; Apple Watch and we are trying to work it for other watches as well. Basically, they are following your heart rate, will transfer the information over to the phone. We use the cloud to pull any information, and then we compute using our algorithm. When we see a jump up in heart rate or other abnormalities, it will send off a signal which pushes back to your smartphone and it’ll set these alerts. Right now, we have just launched the second phase of the study where we are sending the alerts. As I said, it sometimes picks infections, and it does pick up COVID infections as well as asymptomatic cases. We think this is going to be very powerful. It absolutely requires the cloud for this to work because you need to be able to access people all around the world. The study is global, and you can compute everywhere. You keep the costs down actually by running some of the computing areas that are less busy and then distribute the load, so to speak, in the more cost-effective fashion. That’s probably the only way you could do a project like this that uses the cloud and it’s totally scalable. 50 million people in the U.S. wear a smartwatch and right now they could all have an alerting function for COVID-19 if they tuned in to this program. 

Q. This is a global program. So, I imagine that your application has been downloaded globally by people onto the smartwatches – Apple or Fitbit. You mentioned that the elevated heart rate could be a result of various potential activities and not necessarily just COVID. I imagine that the algorithm in some way adjusts for different likely causes and then combines it with other kinds of wearables and so on. What has been the predictive power of these algorithms and how do they hold up across populations or across regions?

Dr. Snyder: We’re going to need more data to answer the last question because the numbers are so small. That’s why we want to have more people join the study. We’ve had several thousand people signed up. We’ve had something like 70 positive cases so far. So, we’ve picked up seventy-three percent of them from different parts of the country, and we’re still improving the algorithms. We want to get that Seventy-three percent up to ninety-five percent or better. We can do that as we pull in more different data types focused on resting heart rate steps and sleep. We pull in different kinds of data; we can improve the algorithms, so we are trying to get as many people signed up as possible. We can detect COVID from different ethnic groups. I’m optimistic it should work for everyone because when people get sick, their heart rate jumps up.

Q. If you do get a million people signed up, what’s the end goal here?

Dr. Snyder: My end goal is to put a smartwatch on everyone on the planet, seven billion people, so they have a health monitor for every single person. That cannot happen today, but that is the long run. The only way to do it is to be following your health in real time, not doing PCR two days later when they get symptoms. You want to be following people while they are healthy in real time, seeing when you see and detect an abnormality and catch and push it back to them as quickly as possible so they can act on it. In the case of a pandemic, if they get one of these alerts, we want it to be as sensitive as possible and as specific as possible, we want them to ultimately self-isolate or get checked right away, before they spread it around to one hundred other people. 

Q. Grace, one of the outcomes of these programs is that you are going to get a lot of data about patients, about consumers and so on. Do you have any plans to harness insights from this data in any way, let’s say, for public health in this case?

Grace: No, that is not the programs intent. AWS is vigilant about our customer’s privacy and data security. Our technology and program policies are really designed with that security and privacy in mind. So, for customers like Dr. Snyder at Stanford and others retain ownership and control of any data and content that they store on AWS, along with the ability to encrypt it, protect it, move it or delete it in alignment with their security policies.

Q. Dr. Snyder, how do the wearable device integrate with Epic or Cerner and make it a part of the longitudinal patient record for diagnostic and treatment on an ongoing basis?

Dr. Snyder: Right now, we’re in the research phase and testing these algorithms, seeing how well it works, and optimizing them. You would have to have a follow up test for that to go into in the record. That’s where we stand now, but in the future, these things will get better validated and they’ll have to get FDA approved, which is not hard to do for simple devices like thermometers. And that will be the case for smartwatches. I think they will be able to get validated and you’ll be able to pull information from them and aspects of that will be in the medical record. Now, my own view is the whole medical record needs to change. Right now, it is not useful to most doctors. It’s hard for them to access information from the record. I’d like to see the record become a living record, meaning it pulls in your data in real time, follows your health, and then can displays it back to a physician in a very useful form in which they can see how is your cardiovascular health, how is your metabolic health, how is your other forms of health? So, I think we should transform the whole medical records system to make it in a useful fashion. An example of this is when they measure your heart rate in a doctor’s office, it’s all over the map and it depends on whether you drove by bike there, what stress is going on, all sorts of things. But you can pull a pretty accurate heart rate right first thing in the morning from someone and get a much better picture of their health. Imagine incorporating that kind of information into a health record for a physician to be able to see what is called a longitudinal record so they can really follow what is going on.

Q. Dr. Snyder, what about patient privacy? In the research phases I guess you are putting some guardrails on what happens to the data, how are you protecting patient data and so on. Can you talk about that?

Dr. Snyder: That is a big concern. So as Grace said, we encrypt everything as it comes. It gets encrypted as we compute it, and we compute encrypted data. As these alerts go out, they get pushed back so that everything is stored. One thing that is important is we do try and pull the data and share it in an anonymized fashion and Amazon has been fantastic for helping. People use the term data lake, but I want to make it a data ocean where we have all these data for people to be able to access again in an anonymous fashion so that we can improve our algorithms and be able to detect disease much better. I think this kind of platform is going to be powerful well beyond the pandemic, meaning you can pull other kinds of information from your smartwatch. You can pull other kinds of health measurements from a smartwatch like dehydration. So, by having data that is accessible, researchers can improve this health monitoring system, I think we can really transform the way people’s health is followed. So, I like to think healthcare instead of sick care, so we can then follow people and better manage their health.

Q. AWS is offering millions in credits to developers worldwide as a part of this program. What has been the response so far? What kind of research projects are we likely to see with a focus on healthcare?

Grace: In the first year of the Diagnostic Development Initiative, we supported around eighty-seven organizations in 70 countries. The organizations included customers that are startups, non-profits, research organizations and businesses. We provided cloud computing credits and technical support to really work backwards from the needs of these researchers to understand how technology could help accelerate or scale their work. In addition to the work that Dr. Snyder’s team has been doing around wearables at Stanford, we’ve also seen organizations focusing on looking at uncovering clues about how COVID-19 presents in individuals and what are some of the impacts or what are some of the outcomes that they’re seeing based on characteristics of their immune response networks been done by the Institute for Systems Biology. Our biology team uses machine learning to try to quantify the silent spread of COVID-19 for those with symptoms. Organizations look at using smartphone cameras to provide accurate and reliable diagnostics within 30 minutes of doing a test. One of the things we are doing this year is broadening the scope of the Diagnostic Development Initiative to cover not just diagnostics but also three new areas. First, early disease detection to help identify outbreaks and trends at both the individual and the community level. Also, prognosis to better understand disease trajectory. And then last for public health genomics to bolster genome sequencing worldwide, which is becoming more important as different variants of COVID-19 emerge.

About our guests

GraceKitzmiller-profilepic

Grace Kitzmiller is a Principal and Senior Product Manager for AWS Disaster Response Program, Grace leads strategy and execution for product development by working backwards from the needs of organizations active across the disaster and crisis lifecycle to learn about the biggest technology challenges they encounter, while preparing for, responding to, or recovering from disasters and crises.

Grace works across AWS people, services, information, and technology, and AWS Partners to build or extend solutions and proofs of concept that can solve those challenges. Grace has been with AWS for over five years and was previously Senior Product Lead for AWS Educate, Amazon’s global initiative to accelerate cloud learning to better prepare students for the cloud workforce. Prior to joining AWS, Grace held leadership positions at a graph database start-up and at a consulting firm focused on using technology to develop solutions for state and federal environmental protection agencies.

Dr.Snyder-profile

Dr. Michael Snyder, Stanford W. Ascherman Professor and Chair, Department of Genetics and Director of the Center for Genomics and Personalized Medicine in the Stanford School of Medicine, is a world-leading expert in genomics, personalized molecular profiling, and precision medicine. Dr. Snyder's Lab has been a pioneering force in the field of precision medicine, including establishing many foundational methods in the field of genomics. He was recruited by Stanford in 2009 to chair the Genetics Department and direct the Center for Genomics and Personalized Medicine. Under his leadership, U.S. News & World Report has ranked Stanford University first or tied for first in Genetics, Genomics, and Bioinformatics every year for the last decade. Dr. Snyder was the first to apply personalized health tracking using multiomics in coordination with wearable devices to predict and prevent disease.

Dr. Snyder also established the first longitudinal integrated multiomic (genomics, proteomics, metabolomics, lipidomics, transcriptomics, microbiomics, and wearables) profiling of humans for personalized health and medicine. This project has produced the most deeply profiled cohort in human history. Most recently, Dr. Snyder has launched Stanford’s Personal Health Dashboard, a novel research app using wearables, currently in exploration for the very early, real-time detection of COVID-19. Additionally, Dr. Snyder has co-founded 13 biotechnology companies including Personalis, Qbio, January AI, Mirvie, & SensOmics.

About the host

Paddy is the co-author of Healthcare Digital Transformation – How Consumerism, Technology and Pandemic are Accelerating the Future (Taylor & Francis, Aug 2020), along with Edward W. Marx. Paddy is also the author of the best-selling book The Big Unlock – Harnessing Data and Growing Digital Health Businesses in a Value-based Care Era (Archway Publishing, 2017). He is the host of the highly subscribed The Big Unlock podcast on digital transformation in healthcare featuring C-level executives from the healthcare and technology sectors. He is widely published and has a by-lined column in CIO Magazine and other respected industry publications.

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THE HEALTHCARE DIGITAL TRANSFORMATION LEADER

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THE HEALTHCARE DIGITAL TRANSFORMATION LEADER

Sign up to get Paddy’s Newsletter that is personally curated by Paddy along with analytical notes on the developments for the week.

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THE HEALTHCARE DIGITAL TRANSFORMATION LEADER

Sign up to get Paddy’s Newsletter that is personally curated by Paddy along with analytical notes on the developments for the week.