Anne Weiler on The Startup Landscape and Disrupting Healthcare from a Place of Empathy

Anne Weiler This Week in Health IT
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This Week Anne Weiler CEO and co-founder of Wellpepper joins us to discuss the startup landscape. What is social media's role in fighting the opioid epidemic? and Empathy as the foundation for healthcare disruption.

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Bill Russell:                   00:07                Welcome to this week in health it where we discuss the news information and emerging thought leaders from across the healthcare industry. This is episode number 26. We are officially halfway through the year. It’s Friday, July six. Today we look at the startup landscape and social media support in fighting the opioid epidemic. Say That 10 times fast. Uh, this podcast is brought to you by health lyrics. Are your strategies constrained by infrastructure or tied to? Are you tied in a knot of applications? We’ve been in your shoes. We’ve been moving health systems to the cloud since 2010. Find out how to leverage the cloud to new levels of efficiency and productivity. Visit Health Lyrics. com to schedule your free consult. My name is Bill Russell. Recovering healthcare cio, writer, consultant, and with the previously mentioned health lyrics. Before I get to our guests and update on our listener drive, we’ve exceeded 200 combined new subscribers to our youtube youtube channel podcast outlets, which means we’ve raised $2,000 for hope builders, which provides disadvantaged youth the life skills and job training they need to achieve enduring personal and professional success.

Bill Russell:                   01:09                I’ve hired their graduates. Their stories are amazing. Uh, just have to love giving these kids an opportunity for a second chance. Uh, we have six more weeks where our sponsor, will give a thousand dollars for every additional hundred subscribers 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. Uh, join us today by subscribing. Tell your friends and, uh, you know, just follow us. We were posting a new video out on youtube every single day. So, uh, today’s guest is the CEO and Co founder of Wellpepper, a clinically validated and award winning platform for digital patient treatment plan. She cofounded wellpepper in late 2012 to address issues in communication and continuity of care after a personal experience when her mother was released from six months in the hospital with no instructions and a month until the next follow up visit. Prior to wellpepper, she was vp of marketing at IQ metrics and director of product management at Microsoft Corporation today. Anne Weiler joins us. Anne welcome to the show.

Anne Weiler:                02:18                Hi Bill.Thanks for having me

Bill Russell:                   02:21                Did I mispronounce your name?

Anne Weiler:                02:25                You did, it’s Weiler.

Bill Russell:                   02:26                There you go. And actually, even in the show notes, I spelled your name wrong. So there we go.

Anne Weiler:                02:34                We’ve actually known each other for a couple of years, you know,

Bill Russell:                   02:36                I know, but we don’t spell each other’s names. It’s Anne 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 I apologize for that. Uh, so you left, you left a well paying job with a strong organization to found a digital start up

Anne Weiler:                03:02                in health

Bill Russell:                   03:02                out of really a personal experience. So tell us a little bit about wellpepper and uh, and your journey now I’m saying wellpepper correctly, right?

Anne Weiler:                03:08                Yes, that is correct. It is Wellpepper So we have a platform for patient facing care plan. So if you think about the, you know, the way care plans have evolved for the most part, they’ve been in the Emr. 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 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 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 our care plans that you can learn from that and you can get something that the patient can follow, can adhere to, and even improve their outcomes.

Bill Russell:                   04:08                So are you, are you leveraging other people’s research? Are you doing some original research as well?

Anne Weiler:                04:13                Well, we’re, we’ve been very fortunate. We have a couple of research partners. One at Boston University Center for Neuro Rehab and one at Harvard. Um, and they’ve done randomized controlled trials. So we’ve, um, we’ve been very fortunate in that we’ve just been able to partner with them. They used the technology to deliver their interventions outside the clinic and then they test 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 an 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 percent of the messages that patients send in a system like this don’t need a response and two percent of them are urgent and those are the ones that you want to get back to the providers, which goes back to our philosophy of this isn’t about managing a patient, this is about enabling and empowering a patient and then connecting them to help when they need it.

Bill Russell:                   05:19                Yeah. One of the things that I think that has been a foundation for our relationship over the years has been. You’re very pragmatic, so you have. Can you give us some stories or some examples of outcomes from your technology?

Anne Weiler:                05:36                Yeah, absolutely. Um, so the randomized control studies that I talked about that, that one was done with people with Parkinson disease and the people who had the digital intervention versus the control group who basically had paper usual care condition. I’m the digital interventions saw nine percent improvement in mobility versus a 12 percent 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 Dr Jonathan Bein 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 95 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, it’s a combination, of course you have to do validated independent research, but you also have to look at as this data’s coming in, what kinds of things can you find in this data and preventing readmissions is a, you know, of course. I think a top goal of any type of system like this

Bill Russell:                   07:03                Right, so one of the things we like to do is ask our guest what’s one thing they’re working on that they’re excited about, maybe we just covered it, but

Anne Weiler:                07:09                yeah, definitely. So we were the two things I’m going to 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 and his water dish and dragging it around. So I’m going to pause. This is going to be the edit part.

Bill Russell:                   07:35                I will pause. You can give the dog water 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.

Anne Weiler:                07:48                Yeah. We have many stories about this dog interrupting conference calls and things. 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.

Anne Weiler:                08:37                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 we announced for care plans. So this is for health systems to be able to share their best practices, have other health systems use them, uh, and our launch partner for that Mayo Clinic. So what happens is as we 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 because it’s not just the data of Mayo Clinic’s patients using these care plans is the data of other health systems using them and we’re also will also make available these protocols like the ones from Boston University and Harvard that were used in these randomized controlled trials. So if you think about it, it’s, it’s an ability to scale patient facing best practices and collect data on them to see what’s working and what’s not working.

Bill Russell:                   09:37                That’s exciting. So you’ve been at this since 2012, so six years.

Anne Weiler:                09:41                Well, not really for some unknown reason. We um, incorporated at the last week of 2012 and I have no idea why we did that. We, we have 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.

Bill Russell:                   10:06                Five years there you go. So here’s what we’re going to do. We’re going to transition to the show. We will do in the news. Then we’ll do some soundbites. I’ll ask you some questions and then we’ll do a social media close. So, uh, let’s go ahead and get started. I’ll start with my story, which is, you know, I figured having someone like yourself on a we, we could talk about this whole startup scene. So startup health just released their midyear report, a funding top $6,000,000,000 across 414 deals and we’re at the halfway point of the year. So July marks the end of another record. Midyear report in digital health more than 6 billion raised in the first two quarters, 2018, 414 deals. That’s the largest bendier deal Count to date and 60 deals more than we reported last year at this time. This increase in deal count is partially due to the rise in a new international hubs of health innovation, particularly across China, which dominates global market with over half a billion US dollars invested.

Bill Russell:                   11:00                As the market expands globally, we’re seeing every section of the market receiving funding from insurance to biometric data acquisition. Okay, so they released this report. They do it, they do it every, I think every six months they actually released a report. I could be wrong, maybe they do a quarterly. Um, and so they have some interesting charts on here. So in 2010 there was a $1.2 billion in funded deals. Halfway through this year. We’re at a 6.1 billion and a 400, 400 some odd, you know, does the appetite to fund digital health startups surprise you at all. And do you think it’s going to continue at this pace?

Anne Weiler:                11:39                I don’t think it’s going to continue at this pace, but I’m always a little bit of a pessimist. I will say that I’ve been very happy to see this increase in funding because when we started I talked to some prominent vc’s in Seattle who said, I don’t think anyone’s funding digital health. And I was like, hm, 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, maybe they weren’t even doing that right? But if you look at this startup health like point, click care is an Emr that focuses on skilled nursing in longterm care facilities.

Anne Weiler:                12:29                So is that digital health? I guess so, but you know, that’s not a new company. So if you look at the 10 largest deals, you’ve 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, pointclickcare 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 of like, what is making up this, this category. I think China’s interesting. Um, 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 was Baidu, who just 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. Jeez, getting rid of their digital health. So I don’t know, you know, there’s a lot of flux 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, then funding as a metric.

Bill Russell:                   13:31                That would be an interesting metric. Well you also have the layoffs at IBM. We see pull back in some areas we see moving forward. The 10 deals that you were discussing, Oscar Lavonne goes on here. Ior, health, some of the others, you know, so, but, but listen to the functions. I mean I just find this interesting. So you have biometric data acquisition, clinical workflow, insurance admin, workflow research, pop health education content and patient empowerment. It really, usually when I look at these lists and I go, okay, I see we’re starting to coalesce around a certain area, you know, whatever patient engagement. 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 then we’ll put more money into it later after we see which one sort of gets traction. I mean, I said it’s not really a question. It’s more of an observation of is the money gonna eventually tell us who the winners and losers are going to be because it doesn’t seem to be yet.

Anne Weiler:                14:46                I don’t think the money ever tells you that. I mean if you look at typical VC firms, only 28 percent of their investments make return. So that’s telling you that 70 percent basically are not. So if you’re looking, 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. I think that the funding is reflecting what’s happening in the market too because all of these new mergers, like I was thinking about this. Well, I’m jumping ahead, but uh, in your question that you gave me an advance, I won’t tell you the answer to it right now, but when you think about all these new companies, like what kind of technology do they need? Are they going to build it all themselves, like the, you know, the JP Morgan, Berkshire Hathaway, the cvs etna, these are different types of companies and what kind of technologies do they need?

Anne Weiler:                15:36                And maybe that’s why the technology investments all over the map too, like we don’t know what the new health care organizations are going to be. Certainly we’re seeing, you know, the payer provider coming together, but then you’re saying seeing payer and Pharma or retail, I guess if you look at cvs. So it’s, there’s a lot of interesting things going on and maybe that’s where we are. Um, someone told me that the Himss venture, uh, events this year, that this year is the year of security and the winter was someone that did basically device security for old devices that could be security risks. So, which is interesting because I’m not seeing, I’m not seeing that in the funding, but maybe security companies don’t need the hundreds of millions of dollars.

Bill Russell:                   16:20                That’s interesting that they’re not in that list. I’m hearing the same thing out in the market is just the amount of money healthcare’s is driving towards security is going up and this device security has been overlooked for decades and now it needs to be addressed. A lot of that is because biometric devices don’t fall under a traditional it, they fall under clinical and clinical didn’t have a sort of a digital mindset around it. And so yeah, so let’s talk about the international metro hubs. So they have this chart and they, you know, London has more deals this year. Uh, India, China a ton more deals. Toronto, uh, Israel, uh, just, I mean you have all these international hubs, um, and obviously that’s going to 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 a, like the u s 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 going to be too much development. That’s going to be too much. Whatever

Anne Weiler:                17:37                We get inbound from other markets all the time, and sometimes we get pulled there from, from partners. We are mostly focused on the US. Our data’s in the US and our product is currently only available in English, um, 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 show stopper that the data is located in the US and if it is then we may just move on from that. Or if it, if it is a show stopper, 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 dedicated instance.

Anne Weiler:                18:28                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’m, I’m actually Canadian. I don’t know if I should say that I am especially the day after or two days after independence day and you know, of course I would love 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 well received there because it is a capitated model. Um, but they’re just, they’re actually possibly slower moving than the u s and I think it’s because the systems are so much larger. Um, and then so we’re 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 you know, if you can’t have someone on the ground in that country that has, or a partner who’s basically completely representing you, it’s very, it’s pretty hard to do that. Plus, I mean there’s still so much opportunity in the US,

Bill Russell:                   19:38                right? Yeah. That makes, that makes a lot of sense. The thing which you said, which sort of struck me is, you can localize pretty easily, but I haven’t even been pulled like it in the southern California market. Obviously we have many languages. Haven’t you had to spin it up for multiple languages just to serve the US market.

Anne Weiler:                20:00                Not yet, but we can do, we can do two things. So when I talking to localized, there’s the chrome of the APP, like the buttons, the okay button and the cancel button. That content can come from anywhere. So the content, we do have content that’s another languages, so if it’s a video explanation or text content. So think of the. The application is we have the building blocks that delivered the various activities to a patient. The chrome on that is in English, but the content within it, the specific instructions could be in any language. Well except for the multibite character. Right? Right. To left. But anyway, I just, as I said that, the videos can obviouslt be in any language. I hear, I hear the engineering team going, no don’t say any language, some languages take up more space so we can deliver content, like educational content and instructions to patients in any language. It’s just like the, the chrome of the app is currently in English. It’s a simple search and replace on strings. So it’s been, it’s ready. Like we, my cofounder and I both came from Microsoft so we knew we had to build a localizable product from day one.

Bill Russell:                   21:11                The takeaway from this is it’s great that there’s a lot of money going in to the space funding innovation and whatnot. We probably need to look at if there is another metric to see what the outcomes of 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

Anne Weiler:                21:33                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 industry metric. Um, you know, a lot of it’s like coming. We were, we were pretty early in actually partnering to do a randomized controlled trial 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 researchers 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. Um, so I think that’s another question. I’ve seen this like the WHO’s actually doing the validation of it and granted, you know, you, you do have to trust some of the data that we’re collecting, but I wouldn’t, you know, 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, because my standard for validated is extremely high and you know, I would want hundreds of thousands of data points on each thing before publishing on it. And we’re still, I think we’re still a little wild, wild west out here on what is, what does validated me and, and what does success mean?

Bill Russell:                   22:46                And that’s where some of the cynicism is coming from, uh, what has been the real impact of digital health and I think it is because we don’t have a body of knowledge yet and we haven’t had enough and enough years yet of doing it. So I’m going to kick it to you for your story. If you could set it up.

Anne Weiler:                23:04                Yeah. So my story it was a story from June from stat news and it was about facebook and they’re redirecting people who are searching for opiods to a federal crisis helpline. 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 show some indication of something else in healthcare, people get very excited. 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 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 searching on facebook to basically buy opioids.

Anne Weiler:                23:58                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 evidence that shows that, that, you know, if your friends are overweight, you’re more likely to be overweight. Well, facebook’s going to know if your friends are overweight at least mostly. I mean, they’re always, for awhile 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 because like 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.

Anne Weiler:                24:49                Um, but I also think that, you know, we’re not looking at some of the key causes in the opiod crisis. So, and I think that, one of my, one of my favorite books, which is Elizabeth Rosenthal’s, an American sickness. She really breaks down how, how do we get to these places and you know, if you think about the opiod crisis, it’s overprescribing, but um, but you can’t blame the doctors for over prescribing because the overprescribing is actually coming from h caps because there’s an h cap 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 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.

Anne Weiler:                25:44                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 we actually in doing a focus group with patients, not patients that were our patients, but just patients, people who had had joints replaced, we heard about a patient who, she took all of the opiates that are prescribed to her because they were prescribed and the doctor told her to do so. So one of the things that we do is in our software pre and post surgery, we’re checking pain medication usage. So 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 here, 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 solving this 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,

Bill Russell:                   26:57                the social media aspect to this is interesting, becasue we know social determinants. We know we can find out more from our search history, social media postings and, and those kinds of things, uh, things we read, reddit histories and that kind of stuff. Um, then then potentially our medical record could 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 of that could be driven from it. Um, you know, I struggle with social media because I don’t, I don’t know if it’s media or a social platform and if it’s one or the other, I think it matters. Um, and uh, you know, some of this is, I mean Zuckerberg will say it’s not, but some of this is just the increased scrutiny that’s happening with facebook. So he gets grilled, he comes back. I mean, his response is essentially look, um, we, we get a tens of billions of posts every day and there’s just no way for us to review all of them.

Bill Russell:                   28:02                Which by the way, I don’t agree, I don’t believe is true. Second of all, he says, well, it’s really self policing. So everyone’s out there. They see a, an opioid, a ad from 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 Ai, they can review all this stuff pretty quickly, give it a score and say, you know, this is a, this is potentially illegal activity. They can escalate that stuff. Have a team that looks at those escalated items and moves them off pretty quickly. The question is, should we know, should we do that? I mean, who’s going to create the filter on those things and say, you know, uh, if it’s, if it’s media than absolutely I want to filter, I want them to look at everything that’s on there and do it. It was a social platform, I’m not sure I want them putting together a filter that says, hey, you know, a bill just said this to his group of friends, but we find that offensive and away it goes. So this, this is that the fine line of who, who determines what, 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 pretty quickly

Anne Weiler:                29:28                people are paying for ads, that’s the thing, in newspaper is not gonna, thinking back to print or even online newspaper, they’re not going to accept an ad from an illegal pharmacy or at least if they do, they’re going to figure it out pretty quickly. So going back to your point of them saying they can’t police that they’re taking money from these ads, they can police it.

Bill Russell:                   29:50                You would think they want to. Actually, I think the thing to highlight here is, you know, you have, they’re the first ones to voluntarily do anything. Reddit, Google, Yahoo, bing. So, um, you know, we can either come down hard on facebook or not come down hard on facebook, so the reality is at least they’re stepping up and saying, for this portion, we’re gonna we’re gonna do our part.

Anne Weiler:                30:18                Yeah, no, I agree. 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 and it’s, hey, we know people are doing this and we’re going to try and get them help as opposed to just ignoring it or profiting

Bill Russell:                   30:33                how much, how much of an impact. I know this is hard to gauge. But I mean, facebook I think has an, I mean less and less of an impact on my kids. Clearly they’ve told me that. Um, but it does have an outsized impact on our community. How much of an impact them self policing and take taking these opioid, uh, ads off their platform. How much of an impact do you think that’ll have? I mean, you, as you noted, the, uh, uh, you know, with, with a total joint replacement and overprescribing, that’s just one aspect of it. This is a social aspect. Will this have a significant impact on it?

Anne Weiler:                31:15                I have no idea. Honestly. I think that’s the nice thing is they’ll know, they’ll know if people click through on those and I think certainly if anybody on one of those hotlines but asking where they heard about it, like it’s definitely trackable. Um, but yeah, going back to the point of like, this is only a small piece of the puzzle. The other pieces of the puzzle are starting upstream and also that 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 found it.

Bill Russell:                   31:55                So I think the good news is we’re mobilized the JPM conference this year. I mean just about everybody who got up there. I mean Geisinger a dignity. I mean everybody got out there, had some aspect of a story to tell on this. They are laser focused on it and I think we’ll get that when it has that kind of mobilization. I think you’re going to see progress. So

Anne Weiler:                32:18                I would say our flag that we’re always waving is involve the patient in it and we want to be upstream and there’s like some of our customers are doing things within the hospital to track, prescribing and track, possibly overprescribing or really keep it, you know, do you really need to prescribe this? 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 exactly what you needed. And so 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 it 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 as well as a secondary benefit.

Bill Russell:                   33:11                So you’re doing self reporting, I assume?

Anne Weiler:                33:14                We are. Yeah. But it’s better than what’s happening right now, which is no report.

Bill Russell:                   33:18                No, I agree. So there’s no reporting. They’re self reporting and then obviously pillpack and other things are, you know, digital reporting somehow getting back, whatever.

Anne Weiler:                33:28                Probably.

Bill Russell:                   33:29                Yeah. Um, I’m sorry, pillpack on the mind because Amazon just. Anyway, I’m going to transition. We introduced a section called soundbites during the section. We typically just toss out questions one to three minute answers if you want to throw back questions at me you can, I cannot guarantee an answer but um, so let’s, let’s just jump into it. What’s the hardest thing about being an entrepreneur in digital health today?

Anne Weiler:                33:58                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 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 going to be possible or even possible today are pretty incredible. And 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, it’s really hard. So it’s kind of hard to have both of these, these things going on at the same time.

Bill Russell:                   34:53                The pace, the pace of play is hard. And I’ve, I’ve been on both sides of this equation now. 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 don’t see. I mean, you clearly see it. I mean, it’s the fax machines. It’s, there’s just so many aspects that need to be brought into a to be digitized and brought forward that the quality of the data that, the number of silos that are available. It’s like, I love your technology. I love where it’s at, not you specifically, but 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 very hard. Um, second question. So what, what makes a great health system partner for a, for a digital health startup?

Anne Weiler:                35:42                Well, you actually just said it. It’s that understanding the bigger picture vision and knowing where to plug things in, because we’re not coming in saying we have to be the only system and in fact 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 going to be part of a larger ecosystem, a larger overall digital patient experience that that’s a great partner. So anyone who comes in and says, yeah, we’re going this way, this isn’t, 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. So those are the easiest ones to work with because they can also look at us and know that they’re not going to get backed into a corner because we have an API, we have microservices, you can deploy us and white labels. You can deploy us part of a larger system and budget, budgets always really helpful.

Bill Russell:                   36:59                Yeah. Um, yeah. Um, people, people with a budget and a problem to solve, uh, tend to be a sense of urgency, tend to be great partners. Uh, so, uh, yeah, one of the most important things for a startup is focus. You know, we talked about this earlier in terms of, you know, will you go to another country and you know, the hardest thing for you is, yeah, there’s opportunity, but you know, let’s stay focused on what our mission was, which started with your mother. Let’s assume you’re starting a new startup. I’m not trying to take you in a new direction right now, 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 and enablement. Is there an area that you’re looking at going, that’s a great area.

Anne Weiler:                37:47                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 it’s really not long time at all. Um, we’ve gone from point solutions to platform solution. 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 too, but 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, 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 know you do a great job of retaining them and recalling them, but how do I find them to begin with?

Anne Weiler:                38:39                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 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 all of these things that a patient needs to do outside the clinic, we’re going to do them. If I’d done that like four years ago, people were just like, you’re crazy. I don’t understand what this is, so I think we would do similar, a similar thing, but even bigger

Bill Russell:                   39:13                Yea and the thing about platforms because I’ve been a part of some platforms in the past and you really have to do one thing well and then people will go, hey, you solved this problem for me. I have this problem. Can you solve that? Can you solve this?

Anne Weiler:                39:26                I mean that’s how we started that. We absolutely had that and being platform people coming from Microsoft. We saw, if we architect this correctly, there’s a lot of repeatability across all of these scenarios.

Bill Russell:                   39:40                Yea an to be honest with you, selling a platform is hard because people just go, I don’t know, they just can’t get their arms around it so that 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 and you’d have a platform behind it.

Anne Weiler:                39:58                Yeah, no totally. And I think if I was going to 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, would we be backed by the whole digital patient experience, multimodal, all of those things,

Bill Russell:                   40:18                consumerization of healthcare consumers, patient consumers. That’s, it’s an interesting challenge that we’re having today. Next question. So what would you tell someone who’s thinking of getting into the Digital Health entrepreneur game today? So I actually toyed around with this when I, when I left St Joe’s and I was gonna go to the digital space. I’ve talked to a bunch of people and it ranged from don’t do it, to, uh, to, you know, to race for it. It’s going to be awesome. So what would you, what would you tell somebody

Anne Weiler:                40:52                somewhere in between those. I would say that you can make a huge difference, but it’s gonna take awhile. One of the, one of the things when, when, uh, when we worked at Microsoft, oftentimes you would have crazy deadlines and you’d have to ship things and at a certain point people would say, look, we’re not saving anyone’s life here. We can’t say that anymore. And, and, and we love that, you know, it’s like we can, we can save someone’s life. We can prevent a complication or a readmission by catching it early. So with digital health, 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 clinicians are not going away. They’re stuck in a system. Don’t be disdainful of them. Understand the pain that they’re feeling like every time I see these articles about physician burnout from Emr, 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 don’t, that should not be the case. So that’s what I say is go for it. But you know, you gotta be patient. It’s going to take a long. It’s going to take a while.

Bill Russell:                   42:26                disrupt from a place of love. I love that terminology. If you could pull one,

Anne Weiler:                42:33                wait, wait, one more thing that I was saving, which is if you’re looking for a new opportunity, I would go back to again, these all these new organizations that are forming, um, because there’s something there they’re going to need something and I think that, you know, one of the challenges of value based care is that the Emrs are not designed to link outcomes to cost. So I dunno if that’s the thing to do, but like all these new organizations are going to need some sort of new technology and I don’t know what it is

Bill Russell:                   43:05                If people didn’t lmw you where from Canada when you say organization they’ll know you’re from Canada,

Anne Weiler:                43:10                why is there an accent there?

Bill Russell:                   43:12                No organization, it’s organization.

Anne Weiler:                43:15                Oh, interesting. I got Rid of a lot of my Canadian accent, but there’s still a few things,

Bill Russell:                   43:21                process and process

Anne Weiler:                43:23                I say process now. When I go to Canada, they don’t like it.

Bill Russell:                   43:29                All right, so I’ll put you in a policy standpoint. So if you could pull one policy lever in healthcare because you don’t have to be honest with you, this, this, uh, a disdain for technology within healthcare from the provider standpoint. I’m not sure, 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 all the things they need to track. So if there’s one thing, one policy lever you could, you could pull, what would that be?

Anne Weiler:                44:03                Well, mine would be actually around fee for service. I think fee for service needs to be reserved for transactional models like urgent care, urgent care, makes sense. Like what did you do to this person? I will pay you for those things, but if you want to keep people healthy, fee for service doesn’t make sense. You know, you actually want to potentially do less for them. Um, so that’s, that’s the one that I would like to see. I don’t think it needs to go away entirely because you got to get paid for what you’re doing, but it needs to be applied in the right scenarios.

Bill Russell:                   44:33                Well actually it’s interesting because fee for service I’ve, I feel like they want to do more because they’ll get paid more and the other, I feel like they want a ration because they get paid a fixed.

Anne Weiler:                44:45                Well that’s the problem. There are some situations where you’re going to 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.

Bill Russell:                   44:54                Right? Yeah. That’s the age old problem. I gonna throw out a bonus question here just because I’m curious your thoughts. You know, big tech players coming in doing things, Amazon, obviously they have a, not only their acquisitions but the jpm Berkshire’s thing. You have Microsoft, uh, reengaging in healthcare a couple of years ago and it’s still moving. Google, whatnot of the big tech health, uh, moves that are going on, who’s gonna have the biggest impact?

Anne Weiler:                45:24                Honestly, I don’t know who’s going to have the biggest impact. Google’s taking a lot of bets, they’ve got deep mind. They’ve got barely. They’ve got unduo 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 don’t know that I would rule out China. 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 incentive because of the population and the fact that the government is needing to provide care for this population. Um, so I think it’s exciting. I love seeing big tech and consumer focused organizations taking a swing at this. Um, but I don’t know who’s going to win. I think will. Hopefully we’ll all win.

Bill Russell:                   46:19                Yeah, exactly. I think that is the case that that $6,000,000,000 going into the market, these big players coming in. And I think that’s just indicative of the fact that, 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, uh, and so that ends up being something we’re willing to pay for something we’re willing to invest our minds and time into. So, and it just has a great impact, a longterm impact. So I think people love being a part of it. Um, I’ve loved our conversation. I’m sorry. We, you know, we’ve, we’ve almost run out of time here. Um,

Anne Weiler:                46:58                I do have a question for you.

Bill Russell:                   47:01                Oh, you do?

Anne Weiler:                47:02                I know I was supposed to be asking you a questions as we went along, but it actually goes back to the intro health lyrics, what you guys do, which workloads are you seeing moving to the cloud and then any particular cloud more than others.

Bill Russell:                   47:22                That’s an interesting question to be honest with you. I think 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 because it’s just a checkbox on a MSA agreement. So it’s, hey, we’re going to do azure and you just check the box and away you go, it’s just easier. And uh, and the other thing is over the years, health systems and payers, providers have hired so many people in that Microsoft stack, so they’re comfortable going from sql to Azure and, and whatnot. Um, and it just I had a cio looked at me and go, I, I understand the benefits of the Amazon stack. He goes, I just, I can’t hire those in this market. I can’t hire those people. Oh, interesting.

Anne Weiler:                48:08                I heard, I heard someone say that as Amazon’s making more moves in healthcare, that’s also pushing people towards Microsoft.

Bill Russell:                   48:16                Oh, interesting.

Anne Weiler:                48:18                Same way that retailers don’t want to be on aws

Bill Russell:                   48:21                maybe,

Anne Weiler:                48:23                but what were, what workloads are like, what are they doing? Because like we see it as we’re an application running on aws. So aws comes in and you know, they’re, they’re doing a specific application, but like what kind of processing or they.

Bill Russell:                   48:37                Yeah, so there’s, there’s, I’m gonna stay high level here. So it’s two things, right? It’s, it’s cloud infrastructure and it’s cloud data, cloud data models. So cloud infrastructure, you can see a lot easier to get the Dev ops 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, 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 Dev ops environment that becomes five because you’re automating and whatnot. And uh, that’s not to say that those people go away, they could do other things. So you can take those 30 people and move them to analytics because we always need more people doing analytics. And the cloud data models, uh, again, it’s just a, 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 so that as you’re creating these platforms that are pulling data from any one of your 800 different silos of data, it’s not traveling as far and whatnot.

Bill Russell:                   49:44                Um, and quite frankly at that point, now you’ve opened up the world of ai machine learning because you’re not, you’re not going to build that locally. You’re going to use Amazon googles. Microsofts. Great. Thank you. Well, thanks. Thanks for giving me that opportunity. I’m going to, I’m going to skip my. Well actually 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, 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. Yup, there you go. So, uh, hey, thanks for coming on the show. Uh, Anne with an e a, is there a, is there a good way for people to follow you on social media?

Anne Weiler:                50:31                Uh, I’m @annewellpepper on twitter, so that’s probably the easiest thing. And I tweet about healthcare, seattle, dogs, mountains, flowers.

Bill Russell:                   50:45                Wow, that’s awesome. So, uh, yeah, so you can follow, you can follow me @thepatientscio, you can follow a writing on the health lyrics website. You can follow the show @thisweekinhit, the website this week in health Uh, and uh, you can catch our videos on the youtube channel. The easiest way to get there, please come back every Friday for news commentary and information from industry influencers. That’s all for now. Thanks Anne.

Speaker 3:                    51:19                Yeah.


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