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The Voice of Healthcare - Episode 3

Co-hosts: Dr. Matt Cybulsky (Principal, Ionia) and Bradley Metrock (CEO, Score Publishing)

Guest: Saji Salam, Founder & CEO, YourMedInfo

Duration: 29 minutes, 37 seconds

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Bradley Metrock: [00:00:00]Episode three of The Voice of Healthcare is all about medical adherence. We interview special guest Dr. Saji Salam about YourMedInfo, his new company, his background, the Echo Show, and much more. Enjoy. 


Bradley Metrock: [00:00:23]Hi, and welcome to Episode Three of The Voice of Healthcare, the podcast designed to examine all aspects of how voice is interacting with the healthcare sector. 


Bradley Metrock: [00:00:35]My co-host is Dr. Matt Cybulsky, principal of IONIA - Matt, say hello! 


Dr. Matt Cybulsky: [00:00:38]Hi everyone. Good to join you again, Brad. 


Bradley Metrock: [00:00:41]Absolutely, Matt, and I'm Bradley Metrock - I'm CEO of a company called Score Publishing based here in Nashville. Our guest here today is Dr. Saji Salam. Dr. Salam, say hello! 


Dr. Saji Salam: [00:00:51]Hey, Brad and Matt - great to be on your show. 


Bradley Metrock: [00:00:54]Thank you for setting the time aside, Saji, and we greatly appreciate that. So rather than me explain all the different things you've done, I'm just going to give you the floor: share with us some of your background, leading all the way up to what it is you're doing right now in the health care space. 


Dr. Saji Salam: [00:01:11]Absolutely. I'm Dr. Saji Salam, I'm a physician by training, and as my friends say, a physician gone bad, or crazy, because I've been doing too many things. Even during med school days, I was the leader of the students' union, and then later, the junior doctors' union, and incidentally we were put in jail by the communist government because we were campaigning for some public health issues. So that was one side of what was going on. I was also involved in the visual media. We brought out some three or four episodes of News Capsule in Kerala, which is the place I lived in India during my med school days. So with all those strange things going on as a physician, I moved on to take a degree in Business Administration, and went off to the U.K. to do my M.B.A. in healthcare. And since then I have been working with firms like Accenture and Deloitte, consulting for health insurance companies, health providers, and specialty pharma companies on a variety of healthcare strategy, management consulting, and technology areas. 


Dr. Saji Salam: [00:02:30]This is what I've been doing for over 15-16 years now, and I've done this in Asia, Europe, and North America. And at a certain point last year, I decided to move into starting up my own venture which has various components of artificial intelligence in healthcare. We started off with the first slice of that using voice technologies - Alexa - for a special problem in healthcare, which is around medication. 


Bradley Metrock: [00:03:06]So, the name of your company is YourMedInfo. What stage of it are you at? Do you have a working prototype on Alexa? Or are you just now getting it going? Where are you in terms of YourMedInfo development? 


Dr. Saji Salam: [00:03:20]Let me just talk a little bit about YourMedInfo. YourMedInfo is a company that is focused to address the growing challenge of non-adherence to prescribed medication, which is costing the U.S. healthcare industry about $300 billion in direct and indirect costs. And if you look at a country like Canada, it is costing Canada about $12 billion. If you look at the U.S., this is about 10 percent of our healthcare budget that is going to waste because people are not adhering to the prescribed medication. 


Bradley Metrock: [00:03:59]I apologize for interrupting let's say that I'm a senior citizen, and I've got some medicine that I need to be taking, or if I'm a cancer patient, I've got medicine I need to be taking. How does your software determine that I'm not taking it and try to get me to follow instructions more often? 


Dr. Saji Salam: [00:04:26]Right. You brought up a good point about patients not taking medication, be it cancer patients or other patients. According to these tests that we have, 50 percent of patients with chronic disease are not adhering to medication. And if you look at those patients with chronic diseases, you are looking at over 160 million in the U.S. by 2020, and for Canada we have a figure of about 10 million by 2036. That's a large number of patients who are living with chronic disease, and 50% of them are not adhering to medication. So before we go to the solution itself, I want to talk a little bit about why this is happening and what we can do to fix it. And then we'll talk a little bit about the role that our application will play. 


Dr. Saji Salam: [00:05:21]According to the studies done, there are a couple of causes for non-adherence - one is behavioral issues such as procrastination, forgetfulness. Another is multiple medications, and keeping track of all that. And then there are complicated dosing schedules. It makes it tricky for patients to keep up with all that. Another big issue around non-adherence is related to picking up from the pharmacy - you might not have somebody to go pick up, or you might not be mobile yourself. That is one issue. And then of course high deductibles and high co-pays in patients with health insurance. These are some of the major causes that lead to non-adherence when it comes to prescribed medications. 


Dr. Matt Cybulsky: [00:06:10]Saji, I hate to interrupt, but where are you getting these figures from? I'm curious. 


Dr. Saji Salam: [00:06:17]The ones I just talked about are in the white paper from ExpertScript - I can send you the link to those papers after the call, if that works. 


Bradley Metrock: [00:06:31]Sure. And we'll put that into the show notes. 


Dr. Saji Salam: [00:06:33]Good, that will be helpful. 


Bradley Metrock: [00:06:36]And I've got a question for you too. 


Dr. Saji Salam: [00:06:37]Sure. 


Bradley Metrock: [00:06:38]This is just a dumb question, and I'm fine to be the person to ask it: what does non-adherence mean? Does it mean that I decided I'm no longer taking anything that those silly doctors asked me to do? Or it means that I just didn't listen clearly enough, and I think I'm following instructions but I'm actually not? 


Dr. Saji Salam: [00:07:00]It is a combination of many of these. In some cases patients just forget - they have too many medications so they're struggling to cope with all of that. And there may be some cases where patients experiment: they're like "Hey, I've been taking this medication for this long. Let me not take it for a week and see what happens." So those situations are there. And then there are some other genuine situations where they're traveling or some other situations which are out of their control. But it could be a variety of these reasons that lead to to non-adherence with medications prescribed. 


Bradley Metrock: [00:07:44]OK. Great. 


Dr. Saji Salam: [00:07:46]Now that we've talked about some of the numbers around it, let's look at what the application can do, because we address some of the issues around this. One issue around non-adherence is the patient education component. Let's say a patient goes to the pharmacy and picks up a medication - or in some cases you may have a senior patient or a bedridden patient, somebody that is at home, and the caregiver goes and picks up the medication. The pharmacist talks to the person; that person comes and talks to the patient; we have a lost-in-translation situation. Here is where Alexa and Echo Dot and our skill can come in handy. We are able to capture information - let's say about drugs like the simplest ibuprofen, or the specialty pharmaceutical drugs like Harvoni - on Alexa. 


Dr. Saji Salam: [00:08:54]We are able to have information stored in Alexa related to medication information, drug interactions, side effects, dosage, frequency, how to take the medication, and things like that. This becomes important even with simple medications like ibuprofen - but it becomes all the more important in medications like Harmoni. A Harmoni pill costs two thousand bucks, right? So you want to make sure. 


Bradley Metrock: [00:09:23]What does that do? 


Dr. Saji Salam: [00:09:24]That is a treatment for hepatitis C. 


Bradley Metrock: [00:09:27]OK. 


Dr. Saji Salam: [00:09:27]But this is a whole new class of drugs called specialty pharma; these are very high-priced drugs. And they are now about one-third of our pharma spend. Every year the U.S. spends about $450 billion in pharmaceuticals. And of that, $150 billion is spent on these specialty pharma high-priced drugs which have complex dosing schedules. Some have issues in terms of how they are constituted and all that. So for such drugs, and drugs in general, the patient may listen to the instructions once - and then that's it. 


Dr. Matt Cybulsky: [00:10:14]How would they listen to the instructions - from person to person or from your skill? 


Dr. Saji Salam: [00:10:21]The current situation is they listen to the pharmacist or the doctor who says "Hey, take this drug, and this is how you should take it." But now on the skill, you can say "Hey, Alexa, I want to know more about this drug." Alexa then goes about saying this is the drug, these are the things you need to know about. And again, Alexa prompts them and asks "Hey, is there a specific area you want to hear more about? Do you want to hear more about drug interactions or how to take the medication?" Then the patient can go back and say "Hey, yeah - I want to know more about how to take the patient medication, or what about the side effects of that drug?" This is very general information about the drug. 


Dr. Saji Salam: [00:11:10]But to your question about how does Alexa know more about the drug: we can provide more personalized patient education, based on the patient's history and the medication the patient is taking. Alexa would open up and say "Hey, Todd, this is your medication. Did you take this specific medication? This is the dose you should be taking, etc." Alexa is able to recognize, based on the patient's name, what medicine the patient is taking. And we do that by bringing in the data from the pharmacy systems into Alexa. 


Dr. Matt Cybulsky: [00:11:58]Fascinating! Now tell us: how does the skill work with compliance and med adherence? Very curious about what you guys have done with that, considering how Alexa communicates with patients or with the consumer. 


Dr. Saji Salam: [00:12:17]A couple of things. Alexa knows that this is Matt, and this is the medication that Matt is taking. Alexa also has the dosage information. Alexa knows that Matt should be taking this medication every six hours. Based on that, we in the back end are able to send text messages and e-mails or even phone calls to the patient, reminding him or her that the medication is due at this time. That is one thing Alexa's able to do. 


Dr. Saji Salam: [00:12:50]Another thing our skill is able to do using Alexa is to send refill requests. If you want to send a refill request to the pharmaceutical company, to the pharmacy, it is very much automated - unlike the current situation where in some countries like Canada it is a long, drawn-out process even if you do it on a computer; you have to key in so many names and codes and all that. But using the YourMedInfo platform, we know that Matt is taking his medication and he needs a refill. 


Dr. Matt Cybulsky: [00:13:33]How do you guys connect that to me as the patient, regarding the meds I'm taking, the schedule, the dosage, the refills? Are you connecting to another data table that's being managed somewhere else? Or how would you guys set that up? (if you're able to talk about it). 


Dr. Saji Salam: [00:13:51]Absolutely, yes. For this personalized information we need to connect to the pharmacy database or the health insurance pro database if they have that sort of data. But we definitely need to connect to a database which has got the patient information and the drugs that the patient is on. 


Dr. Matt Cybulsky: [00:14:17]Has that been a challenge? 


Dr. Saji Salam: [00:14:19]We haven't connected yet. But my background also includes connecting over 50 healthcare applications to an electronic medical record as part of a 700 million implementation of that electronic medical record. So from my experience, I don't think connecting that would be a big challenge. 


Bradley Metrock: [00:14:42]Sure. And I appreciate you sharing that. I just wanted to get a better sense of where you're at, and you're pretty far along, obviously. I've got another question for you. 


Dr. Saji Salam: [00:14:50]Sure. 


Bradley Metrock: [00:14:51]I've been in a situation before - as I mentioned on previous episodes of this podcast, I'm not in the healthcare industry. I just have received health care from time to time; and when I have, something that seems to happen - you know, I'm a taller guy, I'm a bigger guy. And from a prescription standpoint, there are situations that will come up where I don't always need all of it. And I find myself talking to a doctor saying "Do I really need to take the rest of this?" "Yes, you do!" Or "Do I really need to take the rest of this and finish up the prescription?" "No, that's all right." It doesn't quite fit exactly with what you're talking about with medical adherence, prescription adherence, because I've adhered to the prescription but I still have questions. 


Bradley Metrock: [00:15:45]With your platform, are you contemplating being able to have that sort of dialogue that would enable people to ask any sort of extra questions like that? And connect them with a doctor, or help them manage prescriptions even in the event that they have adhered to them? 


Dr. Saji Salam: [00:16:05]Oh, absolutely. When we developed the application, Alexa could not make a call directly to a pharmacy or any other phone number. So we used Ooma, which is another VOiP phone service which is on Alexa, to make the call. But recently Amazon came out with an option to call directly. So if this pharmacy has an Echo device, my Echo device can just call them directly and bypass Ooma. To answer your question: let's say you have a certain prescription with you, and after a week or so you have a bunch of questions. You'd just ask Alexa to connect you to the pharmacy, and then based on the information that we have on you, Alexa would know that this is your pharmacy, this is your primary care physician, etc., and then it will connect you directly. 


Bradley Metrock: [00:17:04]That'd be great! Let's shift gears for a few minutes to the news of the week, and talk about the launch of the Echo Show. Amazon is coming out with the Echo Show this week. It is a combination of the Alexa voice assistant with a pretty large-size screen as well as a camera. And if you see the form factor, it looks like an alarm clock that would sit next to your bed, on your nightstand or whatever, but it can go anywhere, obviously. 


Bradley Metrock: [00:17:41]So Saji, I want to ask you just for some general thoughts on how voice assistants have progressed to the point where we now have the Echo Show this week. Are you excited about it? Or just sort of sitting on the fence waiting to see how adoption is? 


Dr. Saji Salam: [00:18:02]Let me go back a little bit. I just saw the video of the Echo Show and it looks amazing. I want to do a deeper dive into that. When I started off with YourMedInfo, initially my thought was to work with a robotics company, where I would have a combination of voice; also a graphical user interface, like a screen; and vision. When I looked at what was out in the marketplace, I thought it made sense to go with Echo because they'd already sold five million devices. And even though the graphical user interface and the vision was not there, I was hopeful that Amazon would come up with something later on. So I'm really excited, because these were the three things I was looking for and I was going after a robotics company to get that going. But now that Echo Show is here, I'm just excited and I'm curious to see what Echo Show can do for us. 


Bradley Metrock: [00:19:14]It would work well for your platform, just from a layman's perspective - or anybody trying to do something like what you're doing - because you've got the screen, and when you see the promotional pictures that Amazon's put out there of this thing, it's easy to imagine. So: I've got a prescription. Oh shoot, I forgot to take it yesterday. I was supposed to take it twice yesterday and I forgot. Now what? Should I take it three times today? Or should I take it two times, or should I take it none? Oh! Well, you know what? Here's an Echo Show with a screen. Let me get my primary care doctor on the line, able to talk to me face-to-face over video chat, one-on-one. It's easy to imagine that sort of scenario. So I could see why you'd be excited about it. I know I am. 


Dr. Saji Salam: [00:20:13]Yes, absolutely. To me, Echo Show is like a non-intrusive robot at home. Because it's got a vision component, it's got a speech component, and it's also got a screen. And these are the things that you really need. 


Dr. Matt Cybulsky: [00:20:30]Well, it's also it's also got a drop-in feature, so it can be quite intrusive. 


Dr. Saji Salam: [00:20:37]Well, yeah. That is there. But in terms of look-and-feel, you don't have a robot that is clunky and moving about and falling down - it's something that just does the job. It's there and it doesn't look threatening - doesn't look like I have a robot looking after me, taking care of me - it just looks like something on the nightstand, by the patient. I think there's a lot of potential to explore this. 


Dr. Saji Salam: [00:21:12]And this actually fits in with the other kind of things we're doing. I talked about earlier about what we're looking to do in artificial intelligence, and Alexa and voice-based technologies is one. The second one we were looking at is image recognition, and the third is about voice analysis. Using Echo Show, I think we can do some of these. And then depending on how the camera on Echo Show improves - and I'm sure it will, over time - the functionality that can be brought in there from a healthcare perspective would be phenomenal. 


Dr. Matt Cybulsky: [00:21:54]It's a device that offers fantastic output, but it requires input to be useful. How are you handling that issue - knowing you have to have a human interacting with it, regardless of a monitor, regardless of a microphone? What is it about what you're putting together, or even the challenge of getting past that very fact, that you're addressing? 


Dr. Saji Salam: [00:22:22]You mean from the user experience standpoint? 


Dr. Matt Cybulsky: [00:22:27]Well, you're developing a skill and you're developing a tool that humans and patients specifically need to interact with. If Alexa Show and Alexa Echo are great at being output devices, this doesn't necessarily attract me as a consumer or a patient to give it input. 


Dr. Saji Salam: [00:22:48]Correct. In terms of adoption on a large scale, there are some challenges, especially around the cost of the unit. For it to get to a patient, the patient should spend for Echo Dot about 40 bucks. When we talked to the health insurance company in Canada, that was their primary concern. Their point of view was "Let's say we're going to implement this for 1 million people - we're talking $40 million in costs for the device." But it could be a different scenario once the adoption picks up. Already I think Echo Dot has sold about 6 to 8 million devices in the U.S. When we get to a point where we have 100-200 million devices, then this should not be a problem. But the first challenge is about having the devices. 


Dr. Saji Salam: [00:23:50]The second challenge in healthcare, like anything technology-related in healthcare, is security. But Amazon's policies are HIPAA-compliant so they meet the government regulations around health information privacy and security. So that takes care of some of that. But other than that, for the patient I think this is pretty easy to interface. I remember growing up in an age where we were excited about seeing Microsoft Word, and able to use the drag-and-drop features, and click the the buttons. We grew up in that world. But what I am also seeing is that there are some young adopters of Echo. A couple of my friends' kids - four and five years old - are using Echo already. 


Bradley Metrock: [00:24:57]My son would play with it all the time if I let him. 


Dr. Saji Salam: [00:24:59]Yeah! So what what will happen in the future, in my mind, is that language and speech is our natural interface. We don't want to be typing, playing with our smartphone. We would rather be talking to it, which is a natural thing to do. I think that makes it much more easy to attract that demographic: this new generation will be just using voice. They won't be using any keyboards or anything in the future. But for the current generation, there is a huge set of people who are not really conversant with smartphones. Senior citizens. A lot of them manage to use it, and we hear a lot of adoption of Facebook by seniors. But when it comes to something like this, they might be much more prone to use voice-based technology than to play around on screens. 


Dr. Matt Cybulsky: [00:26:06]The challenge that I see as a practitioner, as someone who is desiring patients to interact with the device - I've got to get them to go to it to speak, I've got to get them to go to it to be interested in it. It's got to be more than just sending me, as the patient, information. We have to create a system in which the patient goes towards that tool. With your particular cascade inside of Alexa on the back end, how are you doing that successfully? 


Dr. Saji Salam: [00:26:39]I would look at it in a different way. When we look at it, the challenge around medication adherence is primarily among a certain demographic. The issue is more among seniors. When you come to patients who are in nursing homes, or facilities for long-term care needs and all that, many of them are not in a position to use smartphones. So for them, having a device like Alexa on the bedside, I think, is very convenient. The path of minimum resistance is how I see that. If you look at that population specifically. 


Bradley Metrock: [00:27:29]Some people won't adhere to their medicine no matter what it is you try to do. But what I hear you saying, Saji, is for people who are interested - Alexa and its various hardware form factors (the Echo, the Tap, the Dot, the Echo Show) now present an opportunity to where people who are trying to adhere to it don't have as much of a hill to climb as they might with a smartphone. 


Dr. Saji Salam: [00:27:56]I agree. It is one more tool in the arsenal. Echo by itself does not solve the problem, and that's why we're talking about a multi-channel approach to medication adherence. Apart from the voice piece of it, we're also building out on the platform smartphone apps on both Android and iPhone. And also making it web-compatible when it comes to some of the other uses of the systems that use the web. It is one very critical component of a whole set of things that we have at our disposal. 


Bradley Metrock: [00:28:39]Well, we're going to wrap it up there. We greatly appreciate you, Saji, for joining us. 


Dr. Matt Cybulsky: [00:28:44]Yes, thanks, Saji! 


Bradley Metrock: [00:28:44]We appreciate you sharing information about YourMedInfo. If someone wants to reach out to you, Saji, about YourMedInfo, what is the best way for them to do that? 


Dr. Saji Salam: [00:28:54] 


Bradley Metrock: [00:28:57]And they can contact you through the site? 


Dr. Saji Salam: [00:29:00]Yup. 


Bradley Metrock: [00:29:01]OK. Perfect. 


Dr. Matt Cybulsky: [00:29:02]Excellent. 


Bradley Metrock: [00:29:03]So, thank you very much. We appreciate you. And for The Voice of Healthcare, until next time. 

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